Full text of "Intelligence assessments of the exposure of U.S. military personnel to chemical agents during Operation Desert Storm : joint hearing before the Select Committee on Intelligence, United States Senate, and the Committee on Veterans' Affairs, United States Senate, One Hundred Fourth Congress, second session, Wednesday, September 25, 1996"

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S. Hrg. 104-867

INTELLIGENCE ASSESSMENTS OF THE
EXPOSURE OF U.S. MILITARY
PERSONNEL TO CHEMICAL AGENTS
DURING OPERATION DESERT
STORM

Y 4. IN 8/19: S. HRG. 104-867

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SELECT COMMITTEE ON INTELLIGENCE
UNITED STATES SENATE

AND THE

COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE

ONE HUNDRED FOURTH CONGRESS

SECOND SESSION

WEDNESDAY, SEPTEMBER 25, 1996

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INTELLIGENCE ASSESSMENTS OF THE
EXPOSURE OF U.S. MILITARY
PERSONNEL TO CHEMICAL AGENTS
DURING OPERATION DESERT
STORM

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BEFORE THE

SELECT COMMITTEE ON INTELLIGENCE
UNITED STATES SENATE

AND THE

COMMITTEE ON VETERANS' AFFAIRS
UNITED STATES SENATE

ONE HUNDRED FOURTH CONGRESS

SECOND SESSION

WEDNESDAY, SEPTEMBER 25, 1996

Printed for the use of the Select Committee on Intelligence of the United States
Senate and the Committee on Veterans' Affairs "'iV^^-r.^V'- ,.

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ISBN 0-16-055153-6

SENATE SELECT COMMITTEE ON INTELLIGENCE

[Established by S. Res. 400, 94th Cong., 2d Sess.]
ARLEN SPECTER, Pennsylvania, Chairman

J. ROBERT KERREY, Nebraska, Vice Chairman
RICHARD G. LUGAR, Indiana JOHN GLENN, Ohio

RICHARD C. SHELBY, Alabama RICHARD H. BRYAN, Nevada

MIKE DeWINE, Ohio BOB GRAHAM, Florida

JON KYL, Arizona JOHN F. KERRY, Massachusetts

JAMES M. INHOFE, Oklahoma MAX BAUCUS, Montana

KAY BAILEY HUTCHISON, Texas J. BENNETT JOHNSTON, Louisiana

WILLIAM S. COHEN, Maine CHARLES S. ROBB, Virginia

HANK BROWN, Colorado

TRENT LOTT, Mississippi, Ex Officio

THOMAS A. DASCHLE, South Dakota, Ex Officio

Charles Battaglia, Staff Director

Christopher C. Straub, Minority Staff Director

Kathleen P. McGhee, Chief Clerk

COMMITTEE ON VETERANS' AFFAIRS

ALAN ¥L SIMPSON, Wyoming, Chairman
STROM THURMOND, South Carolina JOHN D. ROCKEFELLER IV, West Virginia

FRANK H. MURKOWSKI, Alaska BOB GRAHAM, Florida

ARLEN SPECTER, Pennsylvania DANIEL K AKAKA, Hawaii

JAMES M. JEFFORDS, Vermont PAUL WELLSTONE, Minnesota

BEN NIGHTHORSE CAMPBELL, Colorado PATTY MURRAY, Washington
LARRY E. CRAIG, Idaho

Thomas E. Harvey, Chief Counsel! Staff Director
Jim Gottlieb, Minority Chief Counsel! Staff Director

(11)

CONTENTS

Page

Hearing held in Washington, DC:

Wednesday, September 25, 1996 1

Statement of:

Bryan, Hon. Richard H., a U.S. Senator from the State of Nevada 12

Campbell, Hon. Ben Nighthorse, a U.S. Senator from the State of Colo-
rado 10

Craig, Hon. Larry E., a U.S. Senator from the State of Idaho 9

Hutchison, Hon. Kay Bailey, a U.S. Senator from the State of Texas 10

Jeffords, Hon. James M., a U.S. Senator from the State of Vermont 13

Joseph, Dr. Stephen C, M.D., M.P.H., Assistant Secretary for Health

Affairs, Department of Defense 24

Kerrey, Hon. J. Robert, a U.S. Senator from the State of Nebraska 16,120

Kerry, Hon. John F., a U.S. Senator from the State of Massachusetts 14

Kizer, Kenneth W., M.D., M.P.H., Under Secretary for Health, Depart-
ment of Veterans Affairs 29

McLaughlin, John E., Vice Chairman for Estimates, National Intelligence

Council 17

Puglisi, Matthew L., Assistant Director, National Veterans Affairs and

Rehabilitation Commission, the American Legion 78

Rockefeller, Hon. John D., a U.S. Senator from the State of West Vir-
ginia 4

Shelby, Hon. Richard C, a U.S. Senator from the State of Alabama 7

Simpson, Hon. Alan K, a U.S. Senator from the State of Wyoming 2,115

Specter, Hon. Arlen, a U.S. Senator from the Commonwealth of Penn-
sylvania 1

Thurmond, Hon. Strom, a U.S. Senator from the State of North Carolina . 6,112

Wellstone, Hon. Paul, a U.S. Senator from the State of Minnesota 11

Testimony of:

Joseph, D. Stephen, Assistant Secretary for Health Affairs, Department

of Defense 36

Kizer, Kenneth W., M.D., M.P.H., Under Secretary for Health, Depart-
ment of Veterans Affairs 50

McLaughlin, John E., Vice Chairman for Estimates, National Intelligence

Council 41

Supplemental material, letters, articles, etc.:

Central Intelligence Agency Report, dated August 2, 1996 on Intelligence

Related to Gulf War Illnesses 60

Article, dated September 6, 1996, from the New York Times 57

Letter, dated September 25, 1996 from Deputy Secretary of Defense

to the Honorable Strom Thurmond 56

Letter, dated January 21, 1997 from Kenneth W. Kizer, M.D., M.P.H.,

to the Honorable Arlen Specter 84

Letter, dated February 13, 1997 from Mr. John H. Moseman, Director
of Congressional Affairs, Central Intelligence Agency, to the Honorable

Arlen Specter 122

Letter, dated March 10, 1997, from Stephen C. Joseph, M.D., M.P.H.,

to the Honorable Arlen Specter 124

Department of Veterans Affairs, Annual Report to Congress, Federally

Sponsored Research on Persian Gulf Veterans' Illnesses for 1995 87

Article, VA Programs for Persian Gulf Veterans 107

(III)

INTELLIGENCE ASSESSMENTS OF THE EXPO-
SURE OF U.S. MILITARY PERSONNEL TO
CHEMICAL AGENTS DURING OPERATION
DESERT STORM

WEDNESDAY, SEPTEMBER 25, 1996

U.S. Senate,
Select Committee on Intelligence and the

Committee on Veterans' Affairs,

Washington, DC.

The Committees met jointly, pursuant to notice, at 10:35 a.m., in
Room SH-216, Hart Senate Office Building, the Honorable Arlen
Specter, Chairman of the Select Committee on Intelligence, presid-
ing.

Present from the Intelligence Committee: Senators Specter, Shel-
by, Hutchison, Kerrey of Nebraska, Bryan, Kerry of Massachusetts
and Robb.

Present from the Veterans' Affairs Committee: Senators Simp-
son, Thurmond, Jeffords, Craig, Rockefeller and Wellstone.

Also Present from the Intelligence Committee: Charles Battaglia,
Staff Director; Chris Straub, Minority Staff Director; Suzanne
Spaulding, Chief Counsel; and Kathleen McGhee, Chief Clerk.

Also Present from the Veterans' Affairs Committee: Tom Harvey,
Staff Director and Chief Counsel; Jim Gottlieb, Minority Staff Di-
rector and Minority Chief Counsel; and Stephanie Sword, Sally
Satel, Dat Tran, Linda Reamy, Dennis Doherty, Elinor Tucker, Jo-
anne Gavalec, Bill Tuerk and Bill Foster, Staff Members.

SSCI Chairman Specter. This joint hearing of the Senate Intel-
ligence Committee and the Veterans' Affairs Committee will now
commence. Senator Simpson, Chairman of Veterans' Affairs, will be
joining us momentarily, as will be Senator Kerrey, Vice Chairman
of the Intelligence Committee. But we've been asked to proceed.

This hearing is designed to explore what the United States Intel-
ligence Community knows about exposure and injuries to U.S. serv-
ice members from Iraqi chemical supplies. We have known for a
long time that Iraq, Saddam Hussein, have very extensive supplies
of chemical weapons. We know that they have been used in the
Iran- Iraq war, that they have been used against the Kurds. And we
suspect that they may have been used against U.S. personnel in
the Gulf War as well.

When the supplies were destroyed with U.S. bombing, there may
well have been injuries to U.S. personnel where we were not antici-
pating that there would be the destruction of those chemical sup-
plies.

(1)

In conversations with top officials from the Department of De-
fense, we have been advised that there were many U.S. personnel,
perhaps running into the thousands, engineers, who may have been
exposed to chemical weapons at a time when those weapons were
being destroyed.

There may well be a violation of international law by the Iraqis,
by Saddam Hussein there, and it may well be that reparations and
damages can be collected from Iraq. Iraq is rich in oil. They have
not been able to sell very much of it lately because of U.N. sanc-
tions, but it may well be that we can look to Iraq to compensate
U.S. personnel on injuries if that is proved to be the case.

Whatever Iraqi responsibility there may be, there is always the
responsibility of the United States government. And we will hear
from Senator Simpson, who has very strong sentiments about that
subject. He and I have been on this subject since 1981 when he was
Chairman of the Veterans' Affairs Committee, as he is today. This
is a subject where I feel very strong, going back to the tales that
my father told me from his experience in World War I. And we
have American soldiers on the front line, exposed to chemical
weapons, where injuries are sustained, and the bottom line is a
United States responsibility.

There is a great deal more that could be said, but we have quite
a number of Senators here and quite a number of witnesses. So,
I will jdeld at this point to my distinguished colleague, the Chair-
man of the Veterans' Affairs Committee, Senator Simpson.

Veterans' Chairman Simpson. That you, Arlen. Thank you very
much.

I'm pleased to be present for this hearing to address these recent
reports that U.S. military personnel may have been exposed to low
levels of chemical nerve agent in March, 1991 during the post-Per-
sian Gulf War bunker destructions in Iraq. I'm always eager to
work with my friend, Arlen Specter, the Ranking Member of the
Veterans' Affairs Committee, Senator Rockefeller, Senator Shelby
and certainly others.

All of us have a great interest in veterans and the care of veter-
ans. Otherwise, we would not be spending $40 billion a year in that
course. That is what we spend for veterans each year for their
health care, disability, compensation, children and spouses. It is a
very large part of the Health and Human Services budget as well
as the Veterans' budget.

We obviously need to know more about the bunker in southern
Iraq. I've read the August 2, 1996 CIA report on the matter as well
as statements that have been issued by the DOD. Questions still
remain. We need more information and it is our intent to try to
gather some of it today in the most productive way possible.

This is not, in any way, an attempt today to round up "the ac-
cused." It is a good faith effort to ground ourselves in the facts so
that we might be able to perform our jobs in a thoughtful manner.

As is often the case in dealing with any issue regarding injured
and ill veterans, many people want to simply sweep aside sound
medical and scientific evidence on an emotional basis and go ahead
and spend the money. And I have no problem with that if we have
the money. If we don't have the money, we've got to figure in the
Veterans' Affairs budget where to get it. When we add an entitle-

ment, where do we get the money? Unfortunately, that sometimes
doesn't puzzle anyone, we just do it.

It is my hope that by hearing's end, we will have a better under-
standing, for example, of why the U.N. report was transmitted to
the DOD in November 1991 and why it was not given more consid-
eration. Was it because of the ugly fog of war? Those are things we
would like to find out. Why did chemical detectors not go off when
the bunker was destroyed by the U.S. forces? What was learned
from the experience? If errors were made, what can be done to en-
sure it does not happen again? These are but a few of the questions
swirling about. We welcome the expert testimony of the VA, the
DOD and CIA. It will be helpful to hear from these fine and experi-
enced witnesses.

I am well aware of the veterans who believe that it is indeed the
low level nerve agent exposure from the bunker destruction that
made them ill. Many of them contact me. They speak from their
hearts. I hear them. Nobody wants veterans who served the nation
with pride and distinction to be suffering — nobody. It is not the
issue here today to see whether we leave people to suffer.

Nobody doubts that many of them are ill. But we do yet know
exactly what is making them sick. Researchers have not been able
to conclude that the symptoms are the result of any one unique ill-
ness. That is why a great research outreach treatment and com-
pensation effort was set in motion during the 103rd Congress. We
are continuing with this aggressive response under my watch as
Chairman of the Senate Veterans' Affairs Committee, and the ef-
fort will obviously continue long after I retire from the Senate.

I do want Americans to know of the Federal Government's vast
involvement with our Persian Gulf veterans. We are not uncaring,
or unresponsive. Indeed, the VA will speak to that in a few min-
utes, but I do want to enter into the record two documents that list
all that the Congress is doing for the sick Persian Gulf veterans.
It is a remarkable compilation. We are a great nation. We have al-
located great resources for those who serve in our country's armed
services. The VA has over thirty — thirty — research projects under-
way. It has three environmental hazards research centers and it
has announced the creation of a fourth center.

The VA has also undertaken a gargantuan epidemiologic survey
and study. It will compare a representative sampling of 15,000 de-
ployed Persian Gulf veterans with a control group of 15,000 veter-
ans who served state-side or in other locations away from South-
west Asia during the Persian Gulf war. Those results are due in
1998.

Congress has also passed legislation requiring that sick Persian
Gulf veterans be compensated by the VA — even if there is no diag-
nosis of disease. That needs to be known to the American people
as we get into these issues of emotion. There are 13 categories of
undiagnosed illnesses for which a Persian Gulf veteran can be com-
pensated. Congress has also mandated that Persian Gulf veterans
receive priority treatment at VA hospitals.

So, that is a brief compilation of the many, many ongoing Fed-
eral activities for the Persian Gulf veterans.

The other agencies included in the multi-agency research effort
are the Department of Defense; the National Institute of Health;

the Centers for Disease Controls, the National Academy of Science,
the Environmental Protection Agency and more.

I will simply say that this Congress and the 103rd Congress have
accomplished a great deal for the nation's Persian War veterans.
Coordinated efforts are underway to treat them, to compensate
them, and to better understand their ailments. They have been up-
permost in my mind and in our minds.

Some of those who are otherwise playing to emotion, fear and
guilt are doing so regardless of fact. Everyone is entitled to their
own opinion, but, no one is entitled to their own facts.

Thank you.

SSCI Chairman Specter. Thank you very much Senator Simp-
son.

Senator Rockefeller, Vice Chairman, the Ranking Member of the
Veteran's Affairs Committee.

Veterans' Ranking Member ROCKEFELLER. Thank you, Mr.
Chairman, very much. And I'm very happy about this joint hearing
of our Committees today.

During the last Congress, the priority of the Veterans' Affairs
Committee was, in fact, oversight of the VA and the DOD response
to the Persian Gulf War mystery illnesses. We conducted four
major hearings, crafted legislation to deal with various unmet
needs, and put out, I think, an excellent staff report.

So, I'm extremely grateful that you've taken the initiative in call-
ing us to do this. Now, I have some very strong things that I want
to say, and they're made out of neither emotion, guilt, or anything
else, but out of the sense of the constitutional oath that I took
when I was sworn into the United States Senate.

The Chairman amply explained the reasons for today's hearings.
And I will not review again the unfortunate disclosures of chemical
agent exposures that bring us here. Suffice it to say that with each
passing week, we hear new revelations of toxic dangers that our
soldiers faced every day in the Persian Gulf. Dangers which almost
everyone but the Department of Defense knew or at the very least,
assumed, were ever present. But the official response is not a pret-
ty one, I'm afraid, and I wish to talk about that.

First, there was the giving of an unapproved drug to our soldiers,
a drug that was meant to be used against a nerve agent that had
never been detected in the Gulf — a drug which DOD's own re-
searchers admit could never have worked against the gas we most
feared would be used, which was sarin.

Then there were the constant chemical alarms that sounded in
the Gulf, heard by our soldiers, but the official response was,
"False alarms, no problem." When other countries or the United
Nations reported detection of chemical-agent releases, the official
U.S. response was always, "No independent confirmation, no prob-
lem." When our soldiers — all of whom were healthy when they left
for the Gulf, virtually by definition — starting coming home ill and
asking for help, the official response was more often than not, "It's
all in your head. No problem." And when there were reports of
mothers and babies with problems as well, the official response was
more often than not, "Not related to the Gulf. No problem."

And now when evidence suggests low-level chemical exposures
afflicted our men and women in the Gulf, the official response is,

therefore, not surprising. And that is, "There's no proof of long-
term health affects from low-level exposures. Therefore, no prob-
lem."

Well, the "no problem" attitude is, in this Senator's judgment,
the problem. And it's time to face the music. Way past time. It's
time for a change at DOD.

Sure, the government is doing a lot to find answers and to help
our veterans. But, I'd have to say that much of that has been
forced on the Department of Defense by the Congress through leg-
islation and otherwise. And I'm convinced that the attitude of "no
problem and we're going to prove it" is what pervades DOD think-
ing and management of this public health mystery. This thinking
has survived too long at the peril of too many people, and it is un-
dermining the credibility and the ability of DOD to do its critical
health care work.

DOD's clinical evaluation program, CCEP, is a sad example.
That's the primary DOD program established to measure the ex-
tent of health problems following the war. The CCEP found large
percentages of our soldiers with numerous health complaints, many
of them serious health complaints. They included 47 percent with
complaints of fatigue, 49 percent with complaints of joint pains, 39
percent with complaints of headaches. And the list goes on and on.

Based on very similar numbers, the Centers for Disease Control
reported, "Significantly greater prevalence of chronic symptoms" in
Persian Gulf War veterans. But, not the Department of Defense.
No. They said the problems that they were finding were not much
greater than the general population. No particular problem here.
No problem and we're going to prove it.

And now comes confirmation of what we all feared, and many
soldiers already knew — that our soldiers did face exposures to
deadly agents like mustard and sarin gases. But, since we've been
so busy tr5ring to prove that there's no problem, we've seen precious
little — at DOD or elsewhere — to probe the health effects of those
deadly nerve agents. More importantly, we have seen little effort
to probe the health effects on soldiers who were exposed to various
insecticides and repellents, and given drugs to fight nerve agents —
drugs which may, themselves, have had the opposite effect, drugs
which may have worsened the effects of sarin. We just don't know
because we've been too busy proving that we have "no problem."

As we've all heard over the past few weeks, the Presidential Ad-
visory Committee on Gulf War Veterans' Illnesses heard what we
would have to call nothing less than scathing reports about DOD's
management of the PGW illness investigation. Words like inflexi-
ble, not credible, superficial, no confidence in DOD's efibrts.

Mr. Chairman, we can do better and we must do better. That's
why I've decided to call upon the President to bring new health
leadership to the DOD. There are many dedicated scientists in and
out of government that will give their all to get to the bottom of
these mystery illnesses. And there are some of us in the Senate
who feel very, very strongly about this and have dealt with many
of these people and are very, very angry — that is an emotion, that
is correct — about the lack of attention that they have been receiv-
ing. But these people who want to get to the bottom of these mys-

tery illnesses cannot do it while those at the top continue to insist
that we have no problem.

It's time for a change, Mr. Chairman, and I thank you.

SSCI Chairman Specter. Thank you very much, Senator Rocke-
feller.

Senator Thurmond, Chairman of the Armed Services Committee,
would you care to make an opening statement?

Senator Thurmond. Thank you very much, Mr. Chairman.

Mr. Chairman, as the senior Member of the Veterans' Affairs
Committee, and I was there when it was organized — as you know,
I've been around here a long time — I'm vitally interested in all vet-
erans and their welfare. The exposure of our armed forces person-
nel to chemical nerve agents is a matter of great concern. The well
being of those who served in the Persian Gulf is an issue that I
have vigorously pursued. As Chairman of the Armed Services Com-
mittee, I have included provisions in defense authorization bills es-
tablishing the Persian Gulf War Registry, providing funding for re-
search, and directing a study on low level exposures to nerve
agents.

Of course, under the lead of Senator Shelby, the Committee did
a study in various nations in the coalition regarding possible expo-
sure, and I commend Senator Shelby for his good work. In 1994,
the Department of Defense sent a summary to Congress to report
the findings of a Defense science board review of Iraq's chemical/
biological warfare use during the Persian Gulf War. That summary
reported that the task force found no evidence of overt intentional
use of biological or chemical weapons by the Iraqis. Furthermore,
their investigation found no credible source of low levels of expo-
sure to chemical weapons, making such exposure unlikely.

Mr. Chairman, we now know that our troops were exposed to
nerve agent released as a result of post-war demolition of chemical
rockets at an ammunition storage area in Iraq. The Pentagon ac-
knowledged it has known since November 1991 that nerve weapons
were stored in Iraq but claims it had not realized U.S. troops were
involved in a March 1991 depot destruction.

In light of these developments it is critical that the government
continue to identify those who may have been exposed to nerve
agents, to assess their health, and to continue to provide medical
care.

Mr. Chairman, as we discuss these concerns, let us keep in mind
that we are dealing with more than words or reports. What is at
issue is the treatment of human beings, men and women who
served their country. This Committee has previously heard the tes-
timony of numerous veterans who went to the Gulf in excellent
health and returned with various illnesses and disabilities. In-
cluded in the list of complaints are swellings, headaches, rashes,
pain in the joints, chronic fatigue, neurological disorders, res-
piratory troubles, and flu like S3rmptoms.

I believe both the Department of Veterans' Affairs and the De-
partment of Defense are concerned for the well being of those who
served in the Persian Gulf. The Department of Veterans' Affairs
has taken action to address the many mysteries surrounding the
various ailments commonly described as Persian Gulf Syndrome.
Such actions include the establishment of the Persian Gulf Registry

to provide health exams and health monitoring of veterans, as well
as the institution of various research programs to identify the
causes of the unexplained illnesses reported by Persian Gulf veter-
ans.

Mr. Chairman, I thank the Chairmen of both the Committees for
holding this important hearing today. I look forward to reviewing
the testimony of the witnesses and working with you to make sure
our veterans are treated fairly and honorably.

And thank you, Mr. Chairman.

SSCI Chairman Specter. Thank you very much, Senator Thur-
mond.

Senator Shelby, would you care to make an opening statement?

Senator, Shelby. Thank you, Mr. Chairman.

Mr. Chairman, I ask that my whole statement be included in the
record.

SCCI Chairman SPECTER. It will be, without objection.

[The prepared statement of Senator Shelby follows:]

Statement of Senator Shelby, Gulf War Syndrome

Mr. Chairman, I wish to address what has been a shameful campaign of obstruc-
tion and delay by the Pentagon and this Administration concerning the Gulf War
Syndrome.

Nearly three years ago, I conducted my own investigation as a member of the
Senate Armed Services Committee and Chairman of the Personnel Subcommittee.
At the request of a growing number of Gulf Veterans from Alabama suffering from
unusual and inexplicable illnesses, I traveled to the Gulf and spoke with our allies.
After interviewing commanders and soldiers directly involved, I concluded that low-
levels of chemical agents were present in the Gulf theater of operations. I found that
Czech Chemical Units and other Coalition units accurately reported to Central Com-
mand Headquarters the presence of chemical agents at various locations. Through-
out my investigation, our coalition allies were forthcoming and very helpful.

In contrast with our allies willingness to cooperate, the Pentagon was reluctant
to provide information necessary to prove or disprove allegations about the presence
of chemical agents in theater. I was constantly challenged by the Department's eva-
siveness, inconsistency, and reluctance to work toward a common goal. As the years
passed, a pattern of denial and delay became standard operating procedure for the
Pentagon.

Mr. Chairman, in June of this year, nearly two-and-one-half years after I submit-
ted my report to the Senate Armed Services Committee, the wall of official denial
began to crumble. Finally, the Pentagon conceded that American Troops may have
been exposed to nerve agents shortly afi;er the Army destroyed a weapons storage
complex in Southern Iraq. At that time, Mr. Chairman, the Pentagon assured us
that only three to four hundred soldiers were involved.

Just last week, in the face of overwhelming evidence — evidence, Mr. Chairman,
that was available over five years ago — the Pentagon finally confirmed what I re-
ported nearly three years ago and what many Gulf War Veterans already knew.
Possibly thousands of soldiers may have been exposed to low-levels of chemical
agents in the Gulf War.

Why the change in position? Well, the Pentagon now tells us that they "recently"
discovered that a second destruction site contained an unknown quantity of rockets
loaded with chemical agents, including the deadly nerve agent sarin. We were told
that the original destruction would create only a three mile dispersion area. With
the discovery of the second site, the dispersion area has now grown to fifteen miles
and may grow further yet.

What else do we know?

We know that the Department's Persian Gulf Veterans' Illness Investigation
Team is aware of at least seven other chemical weapons detections that even the
Pentagon concedes "cannot be discounted."

We know that the Pentagon considers the Czech detections of chemical agents to
be "credible."

We know that Gulf War veterans know of and have testified to many more chemi-
cal alarms than the Pentagon is willing to verify.

For example, members of the 24th Naval Construction Battalion say something
exploded over their camp in Northern Saudi Arabia on January 19, 1991. As a dense
mist descended on their camp, they experienced burning skin, numbness, and dif-
ficulty breathing. We know that their chain of command told them that the explo-
sion was a sonic boom and that they shouldn't discuss what happened that night.
Many of those sailors now suffer from inexplicable illnesses.

One would think, Mr. Chairman, that in the face of an overwhelming body of evi-
dence, the Pentagon would concede that these exposures could be, at the very least,
one cause of the debilitating symptoms known as "Gulf War Syndrome." Unfortu-
nately, Mr. Chairman, concessions by the Pentagon have not been forthcoming.

Mr. Chairman, I welcome the Pentagon's newly discovered candor after nearly five
years of denial, evasion and cover-up. But, the Pentagon has a long way to go before
the whole truth is known. That is why we must keep the pressure on the Pentagon,
the Veterans Administration, and the President to stay the course and get to the
bottom of this for the sake of our soldiers, sailors and airmen.

In hearing after hearing, I have listened to our military commanders tell me that
their greatest asset is their people. When it comes to Gulf War Syndrome, Mr.
Chairman, their actions belie their words.

I cannot tell you why a government that sent its finest into battle remains deaf
to the desperate cries of its faithful. I have heard their voices, Mr. Chairman, and
I intend to take action as you have by holding this hearing. I will ask the Chairmen
of the Defense and VA Committees to also hold hearings so that we can be satisfied
that all that can be done, is being done.

We must uncover the whole story of the Gulf War. We must know that our fallen
heroes are getting all the care that they need. We must also ensure that we are
preparing our troops for similar threats in future conflicts.

If we lack knowledge, we must gain it. If we lack resolve, we must marshal it.
If we lack the courage to face the truth, we must find it. That much, Mr. Chairman,
we owe those who served with honor and distinction and risked everything, simply
because we asked them to.

Senator Shelby. I have a few brief remarks here.

I'm pleased, Mr. Chairman, and I want to commend you for hold-
ing this joint hearing on what has become known as the Gulf War
Syndrome or the exposure of our military personnel to chemical
agents during the Gulf War. However, I must tell you that I'm very
disappointed with the Pentagon and this Administration regarding
this matter. In particular, I'm disappointed mainly because it had
directly affected our troops, and I believe we all have a responsibil-
ity to ensure their health and their welfare.

Just last week, Mr. Chairman, in the face of overwhelming evi-
dence, evidence, Mr. Chairman, that was available over five years
ago, the Pentagon finally confirmed what our Gulf War veterans al-
ready knew, that thousands of our troops were exposed to chemical
agents in the Gulf War. And Mr. Chairman, once again I cannot
help but observe that while our Pentagon talks about force protec-
tion of our troops having a very high priority, that the Defense De-
partment talks about its concern about the health and welfare of
its soldiers. Marines, airmen, and sailors, its inactions, the Penta-
gon's inactions, its delays, its misplaced reports, its incomplete
data after five years, Dr. Joseph, all point toward an Administra-
tion that cautions on the side of what looks good in the eyes of the
press.

The issue, I believe, is a shameful campaign of obstruction and
delay, really delay here. I'm concerned about the Defense Depart-
ment's reluctance to assist our Gulf War Syndrome vets, the de-
partment's lack of caring of its own troops and the fact that our
vets are having to prove their own case.

My bottom line fear, Mr. Chairman, is that we find out that the
Gulf War Syndrome may have been the direct result of U.S. De-
fense Department action. This past week's — or this week's News-

week Magazine notes that in October 1991 the U.N. submitted a
report that has suddenly reappeared from a Washington file draw-
er. This report, which I have not seen, indicates that the U.S.
Army's 37th Engineer Battalion had twice blown up sarin-filled
rockets, setting off huge plumes of smoke and dust that carried
deadly debris downward, possibly exposing as many as 25,000 U.S.
troops. In addition, another article in the same Newsweek issue de-
scribes the deadly combination of an anti-chemical drug taken by
400,000 U.S. troops and a widely used desert insect repellent used
by thousands of these same troops.

Thus, I believe there is information that suggests that the U.S.
government is responsible to a degree for the Gulf War Syndrome.

Mr. Chairman, I look forward to hearing from the witnesses, but
this is a matter that's not going to go away, shouldn't go away, but
should be ventilated, exposed, and we should do something for our
veterans.

SSCI Chairman Specter. Thank you very much. Senator Shelby.

Senator Craig, would you care to make an opening statement?

Senator Craig. Thank you very much, Mr. Chairman.

I will be brief, but I did want to express my concern along with
my colleagues here today. And I thank you and Senator Simpson
for agreeing to hold this joint hearing.

I, like most of us, have been briefed many times on the topic of
chemical weapons' use during the Persian Gulf War and have fol-
lowed very closely announcements about the destruction of the
chemical plants by our forces, and the destruction in Kamisiyah.
All too often, briefings I have received provided new information
which challenged or even contradicted the information received ear-
lier. I have reviewed the testimony of veterans who argue that they
left America as the finest, healthiest force this nation ever pro-
duced, only to come home sick with vague symptoms.

Initially these claims were discounted. But as more and more
veterans come forward with similar symptoms, we cannot continue
to ignore them. And these Committees will not ignore them. You've
heard the Senator say already, there's been tremendous action, tre-
mendous effort to find, and now, of course, the great revelations
are occurring.

The search for answers is never an easy task. However, the an-
swer to the questions about what, if anything, has happened to our
Gulf War veterans is one which we will not ignore and cannot be
ignored any longer. If we have the answers for these mysterious
ailments, we have a responsibility to give these veterans full disclo-
sure. If there are no answers, the government must ensure that
these same veterans have options available to enable them to seek
the help, which they need.

And so I thank you very much, Mr. Chairman. And I ask unani-
mous consent that my full statement become a part of the record.

SSCI Chairman Specter. Without objection, your full statement
will be made a part of the record.

[The prepared statements of Senator Craig and Senator Camp-
bell follow:]

Statement of Larry E. Craig, United States Senator

Mr. Chairman, I look forward with great interest to this hearing on the subject
of mihtary personnel exposure to chemical agents during the Persian Gulf War. Be-
fore we begin however, I just want to add my personal appreciation to the comments
of the many others who have previously recognized Senate Veterans' Affairs Com-
mittee Chairman Al Simpson for his many years of dedication and service in sup-
port of veterans and veterans issues. Senator Simpson (Al). You will be sorely
missed.

I have been briefed many times on the topic of chemical weapons use during the
Persian Gulf War and have followed very closely the announcements about the de-
struction of chemicals by U.S. forces in Khamisiyah. All too often, briefings I have
received provided new information which challenged or even contradicted informa-
tion received earlier. I have reviewed the testimony of veterans who argue that they
left America as the finest, healthiest force this nation has ever produced only to be-
come sick vfith vague symptoms upon their return home. Initially, these claims were
discounted, but as more and more veterans come forward with similar symptoms,
we cannot continue to ignore that which we cannot explain.

The search for answers is never an easy task. However, the answers to the ques-
tions about what, if anything, has happened to our gulf war veterans is one which
we cannot ignore. If we have the answers for these mysterious ailments, we have
a responsibility to give these veterans full disclosure. If there are no answers, the
Government must ensure that these same veterans have options available to enable
them to seek the help they need.

Mr. Chairman, answers are all that I am looking for. And, I suspect that is what
our veterans want as well. Once again, thank you for scheduling this hearing to let
us hear firsthand, more about what actually occurred during the Persian Gulf War.
Using the benefit of hindsight, we may arrive at different solutions today from those
anticipated five years ago.

Statement of Senator Campbell

Mr. Chairman, I would like to thank you for allowing me to submit my statement
for the record as my recent accident unfortunately prohibits me from taking part
in today's hearing. It is particularly unfortunate that I can not be at this last hear-
ing of the 104th Congress to personally thank you for your outstanding and memo-
rable leadership as chairman of the Senate Veteran's Affairs Committee. Your com-
mitment to the needs of the veterans of this country, along vdth your wit and wis-
dom, have made for a leadership style that will not be repeated nor forgotten. You
will truly be missed.

I appreciate your convening today's hearing which vrill examine recent reports
that indicate U.S. military personnel were possibly exposed to chemical nerve agent
during post-Persian Gulf War bunker destructions in Iraq.

Although the past actions of the Department of Defense regarding this are pres-
ently uncertain, I am concerned with the possibility that the DoD could have with-
held information concerning the exposure of U.S. military personnel to nerve agents
during their service in the Persian Gulf War. In the particular instance that we will
examine, several thousand troops may have been exposed as many of those involved
report chronic illnesses that they believe to be linked to this exposure. I certainly
hope that we are able to clarify this information and its negative implications so
that together we may move on to taking care of the our aftlicted veterans.

I know that neither the members of this committee, nor the veterans of this coun-
try want to see a repeat of the Agent Orange fiasco of the Vietnam conflict in which
thousands of veterans were given false information about their condition and later
died from their exposure. It is wrong to expect our young people to go to war, place
their lives in danger, and then return, only to be forgotten during peacetime.

I thank the chair, and please know that I look forward to reading the record of
proceedings and testimony which you have all submitted.

SSCI Chairman Specter. Senator Hutchison, do you care to
make an opening statement?

Senator HUTCHISON. Yes, thank you, Mr. Chairman.

We have heard of the Kamisiyah munitions depot in southern
Iraq that was blown up by the 37th Engineering Battahon. There
was clearly a lack of communication between the CIA, the United
Nations, and our Department of Defense about whether we knew

that our Army had, in fact, blown up this munitions depot and
whether there was chemical weaponry in there. But in fact, it has
been confirmed that there was a nerve agent released as a result
of that in a CIA report.

Now that we have put all of this together, rather than look back-
ward, except for learning experiences, I think it is important that
we do everything possible to try to work with the people that have
possibly been exposed to this nerve gas and other chemicals that
might have happened in the Persian Gulf, because now in addition
to all the symptoms that we're hearing about, it appears that there
are birth defects in the children of these veterans.

I think we need to stop talking about whether this is the DOD
responsibility or the Veterans' Affairs responsibility. We need to
start documenting everything that is happening to those people
who might have been exposed to this kind of chemical and see if
there are, in fact, now more birth defects that are occurring in the
children of these veterans. We need to have good, solid data regard-
less of whose responsibility it is. We need to err on the side of
doing too much, not on the side of doing too little.

I am very pleased that all of you came. I appreciate it. I hope
that at the end of this hearing, if there are questions at all, that
we would go forward to do too much rather than use as a hook that
there are questions and therefore we do nothing.

Thank you.

SSCI Chairman Specter. Thank you, very much Senator
Hutchison.

Senator Wellstone.

Senator Wellstone. Thank you, Mr. Chairman. I, too, will be
very brief so we can get right to the testimony.

I just want to say two quick things. One is I remember Senator
Rockefeller, I think it was in August of '94, when we had a hearing,
and we had some Persian Gulf veterans coming in, and we also ac-
tually had some atomic vets. And there was, I think, unfortunately
a similar pattern. With the atomic vets, we go back to the early
'50s, they had been talking about their health problems and ill-
nesses, and those of their children. And, you know, people kept say-
ing we don't have enough information. They're wrong. And, of
course they're still waiting for just compensation.

Then I remember we had some Gulf veterans talking in very per-
sonal terms about burning semen and very graphic personal testi-
mony. And it was as if nobody believed them.

And so I just think that this hearing is extremely important.
There are some — I'm not here to point the accusatory finger or to
take cheap shots at anybody, Mr. Chairman — but I think there are
some really tough questions that need to be answered.

I'm just going to mention two that I'm very interested in. And
I'll just read them.

One is why did the DOD maintain that no chemical agents were
detected and no chemical munitions were forward deployed in for-
ward areas occupied by the United States in the Gulf when it had
information for nearly five years that an Iraqi munitions depot de-
stroyed by U.S. troops on March 4, 1991, contained chemical weap-
ons, exposing them to mustard gas and sarin, a nerve agent? This

is a why question. This is the sort of question that troubles veter-
ans, their famiUes and all of us.

When first announcing this incident on June 21, DOD estimated
that 300 to 400 American troops may have been exposed to nerve
and mustard gas. Early this month, investigators for a Presidential
advisory panel said that they believed as many as 1,100 were ex-
posed in that incident. However, just last week, the Pentagon an-
nounced a second low-level exposure to chemical weapons also oc-
curred in March, 1991, six days after the first exposure and two
miles from where the first incident took place.

Consequently, the Pentagon said it would warn 5,000 Persian
Gulf veterans that they may have been exposed to nerve gas, and
the DOD spokesman added, Mr. Chairman, quote, "It was possible
the number will grow," end of quote.

Is it any wonder — and I'm sorry, I'm not trying to take advantage
of the situation, and I feel like it's almost too easy to do and I don't
want to do that — but just to pose the question to set the mood for
this very important hearing — and thank you, Mr. Chairman, for
taking the initiative — is it any wonder that our Persian Gulf veter-
ans question the Pentagon's credibility on this issue and strongly
suspect a cover-up? I mean, given the kind of information that
keeps trickling out and given the contradictions.

So, Mr. Chairman, I think it's going to be a tough hearing. I
think each one of these witnesses are professionals. I think it's very
important we listen to them. But I, too, find myself indignant about
what's happened to the veterans and the fact that not everyone has
been as forthcoming with information, as I wish they had been. I
hope this hearing will really provide us with that information.

My final point — and I know, Mr. Chairman, it's beyond the scope
of this hearing — is that I hope right now, the way compensation
is — I understand, this wdll take 30 seconds — you've got to show that
the illness has occurred within two years after having served. I've
got to tell you, with all the information that's coming out. Dr.
Kizer, we've got to change that. Not to do so would be patently un-
fair to the Persian Gulf veterans.

SSCI Chairman Specter. Thank you very much, Senator
Wellstone.

Senator Bryan.

Senator BRYAN. Thank you very much, Mr. Chairman.

We live in a time in which there is a rising tide of public cyni-
cism directed at government at all levels. Sadly, many Americans
believe that their government lies to them, consciously withholds
information, misleads them. I must say that the manner in which
this information with respect to the so-called Gulf Syndrome — the
fatigue, the headaches, the decreased short-term memory, rashes,
pain in the joints, all of which we've heard a great deal about over
the past five years — gives those citizens very little comfort that the
government has been candid and forthcoming.

We were assured for a period of five years that none of our troops
were exposed to chemical weapons in the Gulf. Notwithstanding
the request of this Congress, thousands of veterans, some 60,000
of which have received medical examinations as a result of con-
cerns about their health as a result of their service in the Gulf, we
were told no one was exposed. Now in June, suddenly, as my col-

league, Senator Wellstone points out, we learn that there was expo-
sure. And the question arises — as he points out — why was it for a
period of five years, notwithstanding repeated requests from veter-
ans, from members of Congress, from others, that we were assured
that there were no chemical weapons that our troops were exposed
to. I mean, I must say that I'm eager to hear the response. But this
kind of action is simply unacceptable. We have to do a better job
if we're to retain any kind of credibility.

And now, we're facing a moving target, as Senator Wellstone
pointed out. From 300 to 400 the numbers suddenly leaped to 1,100
and now 5,000 and we're told that there may be many more.

I must say, Mr. Chairman, and I do commend you for convening
this hearing, the American public and particularly those veterans
whose health has been effected as a consequence of their service
deserve an explanation. And they deserve more than just, well,
we're going to get to the bottom of this. They need to be provided
answers now.

So, I'm most interested, Mr. Chairman, to hear the response from
our witnesses as to how this unfortunate situation and the han-
dling of it has evolved.

And I thank you, Mr. Chairman.

SSCI Chairman Specter. Thank you very much. Senator Bryan.

Senator Jeffords.

Senator Jeffords. Thank you, Mr. Chairman.

I appreciate you holding these hearings. To me, it's incredibly im-
portant that we find what happened here. I, too, was present when
we received testimony years ago that there was no evidence of any-
thing occurring. And all of a sudden now we find this evidence. We
find ourselves, once again, discussing the disturbing issue of the
Persian Gulf War syndrome.

This morning our focus turns to the Department of Veteran's Af-
fairs and Defense, in particular the VA's health activities for the
Persian Gulf veterans, as well as the DOD's failure to provide cru-
cial information until five years after demolition operations of the
U.S. Army's 37th Engineering Battalion immediately following the
Gulf War.

The issue of the Persian Gulf W.or syndrome has troubled me for
some time. Congress has continued to try and address the problem,
its medical aspects as best we can with the evidence available to
us. Efibrts by the Senate and the House Veterans' Affairs Commit-
tees have yielded some very positive results. The Persian Gulf War
Veterans Benefit Act of '94 was a bipartisan effort and authorized
the Secretary of Veterans' Affairs to provide treatment and com-
pensation for Persian Gulf War veterans suffering from
undiagnosed illnesses manifested during the war.

Congress also gave the VA the authority to disseminate research
grants for government, non-government and academic institutions
on possible causes and treatment of the Gulf War syndrome. I un-
derstand that Chairman Simpson has spoken on this matter, so I
will not go further.

I have had the opportunity to review some of the material before
us today. The first question that comes to my mind is why the
United Nations Special Commission report took five years to sur-
face. Also, why the DOD dismissed the report in November of 1991

as irrelevant, and why there was not even an attempt to check the
vahdity of the report by the DOD back when it was released.

There are larger, less explainable questions that may not be an-
swered here today. How are our veterans expected to keep their
faith in the Defense Department that at best failed to closely exam-
ine important evidence, while repeatedly and confidently stating
that they had no evidence linking veterans' illness and the expo-
sure of our soldiers to chemical or biological weapons. Also, how is
Congress expected to make educated decisions to provide veterans
treatment, and compensation too, in light of DOD's handling of the
documents which were released.

Had the Presidential advisory panel not reexamined the
UNSCOM report we would not be holding this hearing. And veter-
ans who were exposed to nerve agents would continue to be com-
pletely mystified as to why they're sick. I understand the enormous
cost to the Federal government by providing life-time treatment
and compensation to everyone of some 60,000 veterans in the Per-
sian Gulf registry. However, we should know by now from many
previous experiences on veterans' illness and military service, the
only way to come to solid conclusions based on scientific evidence
is be honest, open and thorough from the beginning. Our veterans
have earned that much and more.

Thank you, Mr. Chairman.

SSCI Chairman SPECTER. Thank you very much, Senator Jef-
fords.

We frequently don't go to opening statements but we have today
because this is, if not the first, one of the first hearings on this sub-
ject and I thought we ought to set the stage. We have a large group
and it's been sort of a rolling arrival of Senators.

We'll now turn to Senator Robb.

Senator ROBB. Thank you, Mr. chairman.

In view of the number of Members participating in this hearing,
I will not make an opening statement. I thank you and Chairman
Simpson for holding this hearing. It's on a topic that has concerned
many of us over a long period of time. And anything that we can
do to provide factual answers to difficult questions will be very
much appreciated by a very large segment of our population. I
think that the intelligence aspects of this are important. I also
think the fact that we're having a joint hearing is a good sign, and
I thank you.

SSCI Chairman Specter. Thanks very much, Senator Robb.

Senator Kerry of Massachusetts.

Senator Kerry of Massachusetts. Mr. Chairman, thank you very
much.

Just a very brief comment, if I may. And I thank both you and
Senator Simpson for holding this hearing. I'd also like to thank, if
I can. Senator Rockefeller for his steadfast attention to this issue.
He really started fighting this battle before anybody else in the
Congress several years ago. And he did it because he was listening
to the complaints of a lot of veterans that a lot of us were hearing.
And there are really two levels on which I think we should express
concern here today about the hearing.

I think all of us read the recent articles about new evidence with
significant consternation, and some increased measure of concern

for the accountability process. And so, it's important to have this
hearing to really begin to sort the series of questions that have
been posed, and responses to them over a period of time, and now
the real state of the evidence.

There's another level on which I think we all ought to express
some concern. There is a great reminder to me in this of the long
battle we fought with respect to Agent Orange, and presumptions
about cancer and exposure to spraying, and the long fight that vet-
erans have to engage in in order to get the government that em-
ployed them to respond to their needs. It was too long a fight. And
I personally am very concerned that now a whole new wave of vet-
erans are going through a similar process.

Some of us were over in the Gulf within hours of the end of the
war. I know John Warner was there, along with myself, the later
John Heinz, and a few others. And I will never forget flying
through a layer of dark cloud, and coming out where the sun
ceased to exist, and there was just blackness with fires everywhere.
And I remember just on the level of air we were breathing being
very happy to leave after a few hours, and talking to some of the
young soldiers there who were exposed to just that quality of air
over a certain period of time.

My attitude has always been that those people deserve presump-
tion. And I think there has been a great sort of still-arm attitude,
fundamentally by those who responsibility it is to make sure that
people who serve their country, and put on the uniform of our
country and go into harm's way, are given every presumption in
their favor.

So, this hearing serves two purposes. It's really to try to clear the
history with respect to that treatment and guarantee that perhaps
there is an attitudinal shift as well as to try to determine the facts
of what happened and what specific cause might be behind the so-
called Gulf War syndrome.

And I thank you, Mr. Chairman, for engaging in this.

SSCI Chairman Specter. Thank you very much. Senator Kerry.

Since the hearing began, I have been provided with a copy of a
letter dated today sent by the Deputy Secretary of Defense — the
Secretary of Defense, I understand it, is out of the country. The let-
ter is sent to Senator Thurmond in his capacity as chairman of the
Senate Armed Services Committee. Neither Senator Simpson, head
of Veterans, nor I received a copy — a little strange. And I think it
is worth noting that the Department of Defense now notes that at
the end of the Gulf War, American troops moved rapidly through
Iraq destroying ammunition storage facilities.

And it goes on. Another line says, the troops were unaware of
this at the time. At this time, we do not know if U.S. troops were
exposed to toxic chemicals during these events. A little strange that
the Department of Defense at this point does not know whether
U.S. troops were exposed to toxic chemicals during these events.

One of the purposes of having extensive statements made by the
Senators today, is to show the very strong sentiment of the Senate
and concern and really sort of disgust about what the Department
of Defense has done. And then Deputy Secretary White says that,
I am today initiating a number of immediate and long-term activi-
ties with regard to the department's efforts toward this issue.

But I think it is significant that it is done on the day when these
hearings are convened, that there is suddenly a response which un-
derscores the need for Senate oversight. It wasn't sufficient that
several weeks ago that the investigators for the President's Advi-
sory Commission said that the credibility of the Defense Depart-
ment has been gravely undermined by it's inquiry into the Iraqi
chemicals injuring U.S. troops.

And just 30 second of a personal note, I had started the comment
but didn't say much, just a word more. When I was growing up,
my earliest recollections were my father, who was wounded in
World War I in the Argonne Forest, carried shrapnel in his legs
until the day he died. And I remember as a child the March on
Washington in 1932. And my father was very sorry he couldn't go
from Wichita, Kansas to that march.

And when someone has a claim, they can ordinarily present it in
court. And if you have medical testimony you can get to a jury, and
a jury can decide the matters. That's not possible when the claim
is against the United States government because of the doctrine of
sovereign immunity. And we've gone through a similar line with
Agent Orange and many, problems. But I think you have a fair
representation of the sentiment of the Senate today, just by way
of a backdrop, as we proceed now to the witnesses.

And we first welcome Mr. John McLaughlin, who is the Vice
Chairman for Estimate of the National Intelligence Council and the
key officer on a matter like servicemen and service women's expo-
sure to toxic materials. Mr. McLaughlin has a very distinguished
record with the CIA, going back to 1972. He's served in most of the
center in the world. And before turning to Mr. McLaughlin let me
jaeld to our distinguished Vice Chairman. I know the Intelligence
Committee had other commitments, and has just joined us.

SSCI Vice Chairman KERREY. Thank you very much, Mr. Chair-
man.

I have a statement that I'd like to include in the record. But I
want to express it in — I say it in my opening paragraph that we
still have considerable amount of gratitude for — and great concern
for the brave men and women who served in the Persian Gulf war
and we owe a great debt to the soldiers who fought to liberate Ku-
wait.

Part of paying that debt, is that we should not let this victory
translate into personal tragedy for anyone, any soldier who may be
suffering from unique and unexplained sicknesses that were caused
by their service. And I appreciate very much this joint hearing, and
look forward to the testimony of the witnesses.

SSCI Chairman Specter. Thank you very much, Senator Kerry.

Welcome, Mr. McLaughlin. We would appreciate if you could
summarize your written testimony. Your full statement will be
made part of the record. We'd like to hold the opening rounds of
questions to five minutes, leaving the maximum amount of time for
dialogue, questions and answers with the panel.

The floor is yours, Mr. McLaughlin.

[The prepared statement of Mr. McLaughlin follows:]

Statement of John E. McLaughlin, Vice Chairman for Estimates, National

Intelligence Council

Chairman Specter, Chairman Simpson, and other Members of the Committees, I
am pleased to appear before you this morning to discuss our ongoing efforts related
to reports of possible exposure of our troops to chemical or biological agents in the
Persian Gulf. Our Director strongly supports CIA's work on this important issue
and continues to encourage us to bring forth important results of our study. Today
I will provide CIA's key findings, background from our analysis on this issue, and
a historical account of our assessments related to Gulf war illnesses.

KEY FINDINGS

On the basis of a comprehensive review of intelligence, we assess that Iraq did
not use chemical or biological weapons or deploy these weapons in Kuwait. In addi-
tion, analysis and computer modeling indicate chemical agents released by aerial
bombing of chemical warfare facilities did not reach U.S. troops in Saudi Arabia.
However, we have identified and will discuss potential fallout concerns in the case
of a rear-area chemical weapons storage bunker in southern Iraq.

CL\ ANALYSIS OF IRAQI CHEMICAL AND BIOLOGICAL WARFARE PROGRAM

CIA has made a concerted effort to conduct a comprehensive review of intelligence
related to Gulf war illnesses since March of last year. Our systematic review of in-
telligence has been done in parallel with DOD's Persian Gulf Investigative Team.
Our study is a detailed investigation into intelligence information — not troop testi-
mony, medical records, or operational logs. The CIA's effort seeks to complement
that of DOD. CIA analysts draw upon and examine DOD information to clarify in-
telligence, to obtain leads, and to ensure a thorough and comprehensive intelligence
assessment. CIA and the Investigative Team continue to coordinate our work. We
inform the Investigative Team of relevant information on potential chemical or bio-
logical exposures for follow-up. Likewise, the Investigative Team shares relevant re-
siilts that aid our study.

Our study involves two areas: research and focused investigations. We have re-
viewed thousands of intelligence documents. Intelligence reports that relate to pos-
sible chemical and biological weapons use, exposure, or location are scrutinized to
determine their credibility and whether follow-up is warranted. In addition, we have
expanded and more fully documented our assessments of Iraqi chemical and biologi-
cal warfare capabilities at the start of Desert Storm. Using this research base, an
investigation is then made into each of the key areas — use, exposure, and location —
and specific areas are examined when possible leads are found. This was a nec-
essary process to assure that our study is comprehensive.

TIMELINE OF CL\ ACTIVITIES

What follows is a chronological account of key events related to CW agent release.
We have decided on this approach because of the complexity of the topic.

CIA has long followed Iraq's chemical and biological programs as part of its mis-
sion to assess CW and BW capabilities worldwide. Before the Gulf war, we assessed
that Iraq had a significant CW and BW capability, including chemically armed
Scuds, and had used chemical weapons on numerous occasions against Iran and its
own citizens. At the start of the air war and continuing to the end of Desert Storm,
the DI's Office of Scientific and Weapons Research established a 24-hour chemical
and biological watch office. These analysts screened incoming intelligence for evi-
dence of chemical or biological weapons use and followed every Scud launch. The
CIA participated in targeting studies for CW and BW facilities that resulted in
targeting of 32 separate sites. It is important to note that Khamisiyah was not iden-
tified or targeted as a CW facility during the war.

CHEMICAL FALLOUT FROM AERIAL BOMBING IN IRAQ

Starting at the left of the chart you see that during the air war the Coalition
bombed suspected CW sites. On the basis of all currently available information, we
conclude that coalition aerial bombing resulted in damage to filled chemical muni-
tions at two facilities — Muhammadiyat and Al Muthanna — both located in remote
areas west of Baghdad. According to the most recent Iraqi declarations, less than
5 percent of Iraq's approximately 700 metric tons of chemical agent stockpile was
destroyed by coalition bombing. In most cases, the Iraqis did not store CW muni-
tions in bunkers that they believed the Coalition would target. The Iraqis stored
many of the CW munitions in the open to protect them from Coalition detection and

bombing. In addition, all known CW agent and precursor production lines were ei-
ther inactive or had been dismantled by the start of the air campaign.

Our modeling indicates that fallout from these facilities did not reach troops in
Saudi Arabia. At Muhammadiyat Storage Area, Iraq declared that 200 mustard-
filled and 12 sarin-filled aerial bombs were damaged or destroyed by Coalition
bombing. Bombing of this facility started on 19 January and continued throughout
the air war. Analysis of all available information leads us to conclude that the earli-
est chemical munition destruction date at Muhammadiyat is 22 January. We have
modeled release of 2.9 metric tons of sarin and 15 metric tons of mustard for all
possible bombing dates. For these days, as for the whole time period of the bombing,
southerly winds occur on only a few days. The board in front of you shows the maxi-
mum downwind dispersions in the general southerly direction for sarin and mustard
cut off at about 300 and 130 km respectively. Neither the first effects nor the gen-
eral population limit levels reached U.S. troops that were stationed in Saudi Arabia.

At Al Muthanna, the primary Iraqi CW production and storage facility, Iraq de-
clared that 2,500 chemical rockets containing about 17 metric tons of sarin nerve
agent had been destroyed by Coalition bombing. Analysis of all available informa-
tion leads us to conclude that the earliest chemical munition destruction date is 6
February. Of the days that the bunker at Muthanna could have been bombed, winds
were southerly on only 8 February. For the general population limit dosage the most
southerly dispersion on 8 February is 160 km, again well short of U.S. troops.

CHEMICAL WEAPONS IN KUWAIT THEATER OF OPERATIONS

Again referring to the timeline, on 4 March 1991 U.S. troops destroyed nerve
agent-filled 122mm rockets in a Bunker at Khamisiyah. On 10 March 1991 they also
destroyed CW rockets at a Pit area near Khamisiyah. The munitions were not
marked, no acute injuries resulted and thus the troops and the CIA were unaware
at the time that chemical munitions were destroyed.

UNSCOM inspected chemical munitions at or near Khamisiyah in October 1991
and identified 120mm sarin/cyclo-sarin (GB/GF) nerve agent-filled rockets and
155mm mustard rounds. At the time it was not clear whether the chemical weapons
identified had been present during the war or whether, as was suspected at other
locations, the Iraqis had moved the munitions afi;er the war and just prior to the
1991 UNSCOM inspection. This uncertainty was only cleared up through the recent
comprehensive review of all intelligence information and an UNSCOM inspection in
May 1996. The following information was obtained by UNSCOM during its October
1991 inspection.

At a pit area about 1 km south of the Khamisiyah Storage Area, UNSCOM found
several hundred mostly intact 122mm rockets containing nerve agent — detected by
sampling and with chemical agent monitors (CAMs).

In an open area 5 km west of Khamisiyah; inspectors found approximately 6,000
intact 155mm rounds containing mustard agent, as indicated by CAMs.

At a third location, a single bunker among 100 bunkers, called "Bunker 73" by
Iraq, remnants of 122mm rockets were identified.

The Iraqis claimed during the October 1991 inspection that coalition troops had
destroyed Bunker 73 earlier that year. These Iraqi statements were viewed at the
time wdth skepticism because of the broad, continuous use of deception by the Iraqis
against UNSCOM.

During the 1992 to 1995 time frame, CIA's effort focused on identifjdng Iraq's re-
sidual CW and BW stockpile. This effort consisted of assessing Iraq's declarations,
refining collection requirements, and interpreting intelligence to attempt to root out
remaining Iraqi CW capabilities. The issue of Gulf war illnesses surfaced to national
prominence in about mid- 1993. CIA was not brought into this issue until March of
1995.

As mentioned earlier, we initiated a comprehensive review of all intelligence relat-
ed to Gulf war illnesses in March of 1995. In September 1995, CIA identified
Khamisiyah as another site for potential CW agent release and asked the DOD's
Investigative Team to look into whether U.S. troops were there. We continued re-
searching the issue together and by early March 1996, information was developed
that enabled us to conclude that U.S. troops did blow up Bunker 73. However, we
still had some uncertainty as to whether the rockets in the bunker were actually
chemical.

UNSCOM lacked specific documentation on the type of rockets in Bunker 73 cre-
ating concerns for UNSCOM regarding chemical munitions accounting. These con-
cerns about tjT)e of munition, especially given more recent UNSCOM understanding
of the many varieties or rockets, motivated them to perform a new inspection at
Khamisiyah.

UNSCOM's May 1996 investigation removed uncertainty about the type of muni-
tions present in Bunker 73 because they documented the presence of high density
polyethylene inserts, burster tubes, fill plugs, and other features characteristic of
Iraqi chemical munitions. In addition, Iraq told the May 1996 UNSCOM inspectors
that Iraq moved 2,160 unmarked 122mm nerve agent rockets to Bunker 73 from the
Al Muthanna CW site just before the start of the air war. According to Iraq, during
the air war they moved about 1,100 rockets from the bunker to the pit area 2 km
away.

MODELING OF RELEASE OF AGENTS FROM BUNKER 73 AT KHAMISIYAH

Modeling of the potential hazard caused by destruction of Bunker 73 indicates
that an area around the bunker at least 2 km in all directions and km downwind
could have been contaminated at or above the level for causing acute symptoms in-
cluding runny nose, headache, and miosis as you see in this figure. An area up to
25 km downwind could have been contaminated at the much lower general popu-
lation dosage limit. ^ Based on wind models and observations of a video and photo-
graphs of destruction activity at Khamisiyah, we determined that the downwind di-
rection was northeast to east.

Some of the modeling assumptions we used were based on data from US testing
in 1966 that involved destruction of several bunkers filled with GB rockets of simi-
lar maximum range to Iraqi rockets found in Bunker 73.

MUSTARD ROUNDS NEAR KHAMISIYAH

During the May 1996 inspection, Iraq also told UNSCOM that the 6,000 155mm
mustard rounds UNSCOM found in the open area at Khamisiyah in October 1991
had been stored at one bunker at An Nasiriyah until 15 February 1991, just before
the ground war. Iraq claims that fear of Coalition bombing motivated An Nasiriyah
depot personnel to move the intact mustard rounds to the open area 5 km from the
Khamisiyah Depot, where the rounds were camouflaged with canvas. Subsequently,
we have been able to confirm that the munitions were moved to this area about this
time. Therefore, based on the inspection and confirmation we conclude that the
bombing of An Nasiriyah on 17 January 1991 did not result in the release of chemi-
cal agent.

ONGOING ANALYSIS OF PT ROCKET DESTRUCTION

Iraq told UNSCOM in May 1996 that they believed occupying coalition forces also
destroyed some pit area rockets. DOD's investigation into this possibility has indi-
cated that US soldiers destroyed stacks of crated munitions in the pit on 10 March
1991. From analysis of all information, we assess that up to 550 rockets could have
been destroyed. Modeling of weather conditions indicate that the wind was almost
due south. We are now modeling the actual hazard area and plan to finish our anal-
ysis on the pit in the near future.

CLOSING STATEMENT

We will continue to be vigilant in tracking any lead that surfaces in the future.
If we find any information pointing to chemical or biological agent exposures or im-
pacting significantly on the issue of Gulf War veterans' illnesses, we will again work
with the Department of Defense to announce those findings.

STATEMENT OF JOHN McLAUGHLIN, VICE CHAIRMAN FOR
ESTIMATES NATIONAL INTELLIGENCE COUNCIL

Mr. McLaughlin. Chairman Specter, Chairman Simpson, and
other Members of the Committees, I'm pleased to appear before you
this morning to discuss our ongoing efforts related to reports of
possible exposure of our troops to chemical and biological agents.

Veterans' Chairman SiMPSON. If you could pull that over, please,
towards yourself.

' This dosage from Army manuals is for protection of the general population and is a 72 hour
exposure at 0.000003 mg/m3 — significantly lower than the 0.000 lmg/m3 occupational limit de-
fined for 8 hours.

Mr. McLaughlin. I'm pleased to appear before you to discuss
this issue. Our director strongly supports the CIA's work on this
important issue and continues to encourage us to bring forth im-
portant results of our study. I can assure you we have a strong
force of analysts who are working nearly around the clock on this
issue and we will bring our findings to your attention as soon as
we can.

Today, I'm going to provide CIA's key findings, background from
our analysis on this issue, and a historical account of our assess-
ments related to Gulf War illnesses.

Let me preview the key findings. On the basis of a comprehen-
sive review of intelligence, we assessed that Iraq did not use chemi-
cal or biological weapons or deploy these weapons in Kuwait. In ad-
dition, analysis and computer modeling indicate that chemical
agents released by aerial bombing of chemical warfare facilities did
not reach U.S. troops in Saudi Arabia. However, we have identified
and will discuss potential fallout concerns in the case of a rear area
chemical weapons storage bunkers in southern Iraq.

Let me now discuss our analysis of Iraqi chemical and biological
warfare program. We've made a concerted effort to conduct a com-
prehensive review of intelligence related to Gulf War illnesses since
March of last year. Our systematic review of intelligence has been
done in parallel with DOD's Persian Gulf investigation team. Our
study is a detailed investigation into intelligence information, not
troop testimony, medical records or operational logs. Our effort
seeks to complement that of DOD. CIA analysts draw upon and ex-
amine DOD information to clarify intelligence, obtain leads, and to
ensure thorough and comprehensive intelligence assessments.

CIA and the investigative team continue to coordinate our work
and we inform the investigative team of relevant information as it
arises. Likewise, they keep us informed.

Our study involves two areas: research and focused investiga-
tions. We've reviewed thousands of intelligence documents. Intel-
ligence reports that relate to possible chemical and biological weap-
ons use, exposure or location are scrutinized to determine their
credibility and whether follow-up is warranted. In addition, we've
expanded and more fully documented our assessments of Iraqi
chemical and biological warfare capabilities at the start of Desert
Storm.

Using this research base, an investigation is then made into each
of the key areas: use, exposure and location. And specific areas are
examined where possible leads are found.

Now let's take a look at a time line of CIA activities on this
issue. What follows is a chronological account of key events related
to CW agent release. We've decided on this approach because of the
sheer complexity of this topic.

CIA has long followed Iraq's chemical and biological programs as
part of its mission to assess CW and BW capabilities worldwide.
Before the Gulf War, we assessed that Iraq had a significant CW
and BW capability, including chemically armed SCUDS, and had
used chemical weapons on numerous occasions against Iran and
against its own citizens.

At the start of the air war and continuing to the end of Desert
Storm, our analysts established a 24-hour chemical and biological

watch office. These analysts screened all of the incoming intel-
ligence for evidence of chemical or biological weapons use. And they
followed every SCUD launch. We participated in targeting studies
for CW and BW facilities that resulted in targeting of 32 separate
sites. It's important to note, that Khamisiyah was not identified or
targeted as a CW facility during the war.

Focusing now on chemical fallout from aerial bombing in Iraq.
Starting at the left of the chart, you see that during the air war
the coalition bombed suspected CW sites. On the basis of all cur-
rently available information, we conclude that coalition aerial
bombing resulted in damage to filled chemical munitions at two fa-
cilities: Muhammadiyat and Al Muthanna, both located in remote
areas west of Baghdad. According to the most recent Iraqi declara-
tions, less than five percent of Iraq's approximately 700 metric tons
of chemical agent, was destroyed by coalition bombing. In most
cases the Iraqis did not store CW munitions in bunkers that they
believed the coalition would target. The Iraqis stored many of the
CW munitions in the open to protect them from coalition detection
and bombing.

In addition, all known CW agent and precursor production lines
were either inactive or had been dismantled by the start of the air
campaign. Our modeling indicates that fallout from these facilities
did not reach troops — these facilities to the west of Baghdad, did
not reach troops in Saudi Arabia. At Muhammadiyat storage area,
Iraq declared that 200 mustard-filled and 12 sarin-filled aerial
bombs were damaged or destroyed by coalition bombing.

Bombing of this facility started on 19 January and continued
throughout the air war. Analysis of all available information leads
us to conclude that the earliest chemical munition destruction data
at Muhammadiyat is 22 January. We have modeled release of 2.9
metric tons of sarin and 15 metric tons of mustard for all possible
bombing dates.

SSCI Chairman SPECTER. Mr. McLaughlin, you're right in the
middle of an important point, take a little more time.

Mr. McLaughlin. OK. Let me — let me try and summarize this
testimony, rather than giving it to you word for word. Essentially,
when we looked at that bombing in northern Iraq, we modeled the
results of the coalition bombing, and the board over here will show
you that we think the maximum downwind dispersions in a general
southerly direction for sarin and mustard cut off at about 300 and
130 kilometers, respectively. Neither the first effects nor the gen-
eral population limit levels reached U.S. troops that were stationed
in Saudi Arabia.

At Al Muthanna, we did a similar modeling and we determined
that the winds were southerly on only 8 February. For the general
population limit dosage, the most southerly dispersion on 8 Feb-
ruary is about 160 kilometers — again, well short of U.S. troops.

Now let me turn to the question of chemical weapons in the Ku-
wait theater of operations. Again, looking at this timeline, on 4
March, U.S. troops destroyed nerve agent-filled 122-millimeter
rockets in a bunker at Kamisiyah. On 10 March, 1991, they also
destroyed CW rockets at a pit near Kamisiyah. The munitions were
not marked. No acute injuries resulted and thus the troops and the

CIA were unaware at the time that chemical munitions were de-
stroyed.

UNSCOM inspected chemical munitions at or near Kamisiyah in
October of 1991, and identified 120-millimeter sarin/cyclo-sarin
nerve agent-filled rockets and 155-millimeter mustard rounds. At
the time, it wasn't clear whether the chemical weapons identified
had been present during the war or whether, as was suspected at
other locations, the Iraqis had moved the munitions after the war
and just prior to the 1991 UNSCOM inspection. This was only
cleared up — this uncertainty — with a comprehensive review of all
intelligence, and an UNSCOM inspection in May 1996.

The following information — let me just summarize what the
UNSCOM found in 1991. At a pit area about a kilometer south of
the Kamisiysih storage area, UNSCOM found several hundred
mostly intact 122-millimeter rockets containing nerve agent. In an
open area about five kilometers west of Kamisiyah, inspectors
found about 6,000 intact 150-millimeter rounds containing mustard
agent as indicated by tests on the scene. At a third location, a sin-
gle bunker among 100 bunkers called Bunker 33 by Iraq, remnants
of 122-millimeter rockets were identified. The Iraqis claimed dur-
ing the October '91 inspection that coalition troops had destroyed
Bunker 33 earlier that year. These Iraqi statements were viewed
at the time with skepticism — and Bunker 73 — these statements
were viewed with skepticism because of the broad continuous use
of deception by the Iraqis against UNSCOM.

During the 1992 and '95 time frame, CIA's effort focused on iden-
tifying Iraq's residual CW and BW stockpile. This effort consisted
of assessing Iraq's declarations, refining collection requirements,
interpreting intelligence to attempt to root out remaining Iraqi CW
capabilities. The issue of Gulf War illnesses surfaced to national
prominence, as you know, in about mid-'93. CIA did not begin its
independent review of this issue until March of '95.

As mentioned earlier, we initiated a comprehensive review of all
intelligence at that time. In September of '95, we identified
Kamisiyah as another site for potential CW agent release, and
asked the DOD's investigative team to look into whether U.S.
troops were there. We continued researching the issue together
and, by early March '96, information was developed that enabled
us to conclude U.S. troops did blow up Bunker 73.

We still had some uncertainty, however, about whether the rock-
ets in the bunker were actually chemical. UNSCOM lacked specific
documentation on the type of rockets in that bunker, creating con-
cerns for UNSCOM regarding chemical munitions accounting.
These concerns about type of munition, especially given more re-
cent UNSCOM understanding of the many varieties of rockets, mo-
tivated them to perform a new inspection at Kamisiyah. They did
this in May 1996. That removed uncertainty about the type of mu-
nitions present in Bunker 73 because of the various things they
found: high density polyethylene inserts, burster tubes, fill plugs,
other things that are associated with Iraqi chemical munitions.

In addition, Iraq told the May 1996 UNSCOM inspectors that
Iraq moved over 2100 unmarked 122-millimeter nerve agent rock-
ets to Bunker 73 from the Al Muthanna site in northern Iraq just
before the start of the war. According to Iraq, during the air war,

they moved about 1100 rockets from the bunker to the pit area two
kilometers away.

Now, let me tell you what we found when we modeled the release
of agents at Bunker 73. Modeling of this potential hazard at Bunk-
er 73 indicates that an area around the bunker, at least two kilo-
meters in all directions and four kilometers downwind, could have
been contaminated at or above the level for causing acute symp-
toms including runny nose, headache, miosis as you see in this fig-
ure. An area up to 25 kilometers downwind could have been con-
taminated at the much lower general population dosage limit.
Based on wind models, and observations of a video, and photo-
graphs of destruction activity at Kamisiyah, we determined that
the downwind direction was northeast to east.

Some of the modeling assumptions we used were based on data
from U.S. testing in 1966 in bunkers filled with similar rockets of
U.S. manufacture.

Now, let me talk about the mustard rounds found near
Kamisiyah. During this May 1996

SSCI Chairman Specter. Mr. McLaughlin, would you do your
best to summarize?

Mr. McLaughlin. All right, let me move on to the pit rocket de-
struction.

Iraq told UNSCOM in May '96 that they believed occupying coa-
lition forces also destroyed some rockets in a pit area near this
bunker. DOD's investigation into this possibility has indicated that
U.S. soldiers destroyed stacks of crate munitions in the pit on 10
March 1991. From analysis of all information, we assess that about
550 rockets could have been destroyed. Modeling of weather condi-
tions indicate the wind was almost due south. We are now model-
ling the actual hazard area and plan to finish our analysis on the
pit in the near future. Let me just say we're working this very
hard, nearly around the clock, and we'll report the results of this
modelling to you as soon as it's feasible.

In sum, I would just say you can count on us to be continuously
vigilant in tracking any lead that surfaces in the future on this. We
share the concerns you've expressed, and we will work it and report
our findings to you as soon as we can.

SSCI Chairman Specter. Thank you very much, Mr.
McLaughlin.

We now turn to Dr. Steven C. Joseph, who is the chief Depart-
ment of Defense health officer in his capacity as Assistant Sec-
retary of Defense for Health Affairs. Dr. Joseph has a very distin-
guished academic and professional record, graduating from Har-
vard College, Yale University School of Medicine, and Johns Hop-
kins, where he has a masters in Public Health. He was dean at the
school of public health at the University of Minnesota, and has
served as commissioner of health for New York City.

Welcome, Dr. Joseph, and the floor is yours.

Dr. Joseph. Mr. Chairman, distinguished Members of the Com-
mittee, I thank you for this opportunity to present a current as-
sessment of the Kamisiyah incidents, other reports of detection and
the initiatives under way for our Persian Gulf veterans.

With your permission, I'd ask that my complete statement

SSCI Chairman SPECTER. Your full statement will be made part
of the record and to the extent you can summarize within the five
minute limit, the Committee would appreciate it — Committees
would appreciate it.

[The prepared statement of Dr. Joseph follows:!

Statement of Stephen C. Joseph, M.D., M.P.H., Assistant Secretary of
Defense for Health Affairs

Khamisiyah represents a major change in our understanding of the health issues
and potential exposures of our troops during and following Operations Desert Shield
and Desert Storm. This change has required us to re-examine our responses to Per-
sian Gulf Illnesses, and to expand our unprecedented, existing clinical, investigative,
declassification and research programs. In light of Khamisiyah, there are seven spe-
cific initiatives the Department of Defense is undertaking. These initiatives are:

a. Using our own capabilities and those of the CIA, we are modeling and inves-
tigating all aspects of the bunker 73 demolition, the Khamisiyah pit destruction, the
24 Fox vehicle and M256 positive detections, and the two Czech detections.

b. At the direction of the Deputy Secretary, the Army Inspector General will track
the chronology of the Khamisiyah incidents.

c. Also at the direction of the Deputy Secretary, the Assistant to the Secretary
of Defense for Intelligence Oversight, Walter Jaiko, will compile a chronology of
events related to the Khamisiyah incidents and the information concerning those in-
cidents.

d. We are undertaking an expansion of our clinical investigations of those troops
known to have been in potential "exposure zones."

e. We have asked the Institute of Medicine, and they have agreed, to have their
Committee on the Persian Gulf Syndrome Comprehensive Clinical Evaluation Pro-
gram (CCEP) re-assess our CCEP clinical protocols in light of plausible incidents of
exposure to chemical warfare agents.

f. We have expanded our program of research to include projects examining pos-
sible clinical effects of low level exposure to chemical warfare agents.

g. We have asked the Interagency Security Classification Appeals Panel to under-
take an objective review of the documents placed on GulfLINK and to make rec-
ommendations regarding declassification of documents and their posting on the
Internet.

Khamisiyah has changed the paradigm of our approach to Persian Gulf Illnesses.
Previously, we had a number of Gulf War veterans who were ill and we sought ex-
planations for those illnesses. Now, we have evidence of possible chemical warfare
agent exposures. It is imperative that we now attempt to find clinical evidence that
might be linked to those exposures in our troops who were in the "exposure zones."

The Department, while dedicating its energies to the programs addressing Persian
Gulf Illnesses and working to re-orient and expand those programs based on the
Khamisiyah information, still must look to the future. The Department has initiated
a medical surveillance program for all deployments which significantly improves the
health screenings prior to and following deployment and requires enhanced preven-
tive medicine and environmental monitoring activities throughout the deployment.
We will know the health status of our forces and we will have detailed documenta-
tion of potential exposures.

STATEMENT OF DR. STEPHEN JOSEPH, ASSISTANT SEC-
RETARY FOR HEALTH AFFAIRS, DEPARTMENT OF DEFENSE

Dr. Joseph. President Clinton promised that we would explore
all avenues of potential cause for illnesses, that we would take care
of the veterans who believe their Gulf War experience has resulted
in a degradation of their health, and that this Administration
would put its resources into scientific research to find explanations
for these illnesses.

My comments today will address first the most current informa-
tion we have on the demolition of Bunker 73 and the destruction
of weapons in the pit at Kamisiyah, as well as other reports of de-
tections. Then I will describe the actions DOD has taken as a re-
sult of this information. Finally, if you permit me with time, I'll

outline the programs the Department has taken to fulfill the Presi-
dent's commitment to care for our Persian Gulf veterans.

Kamisiyah's ammunition storage area, also known as Tel-Alam
in southern Iraq, was a large ammunition storage depot before and
during Operations Desert Shield and Desert Storm. The Kamisiyah
facility contained nearly 100 ammunition storage bunkers, covered
a 25 square kilometer area.

Prior to the Gulf War, the intelligence community did not list
Kamisiyah itself as a suspect chemical weapons site. As a result,
it was not targeted as a chemical facility for coalition bombing. It
was not until October 1991, some eight months after the end of
Desert Storm that information was identified suggesting the facil-
ity did store chemical weapons during Desert Storm.

As you've heard, an UNSCOM team inspected the Kamisiyah
ammunition area in October '91 and I will not repeat the detail
from Mr. McLaughlin's testimony about the numbers of the muni-
tions. UNSCOM inspectors found several hundred 122-millimeter
rockets with a mixture of the chemical nerve agents sarin and
cyclo-sarin. These munitions were found in several heaps or piles
in a large pit or revetment. Most of these rockets were intact but
some appeared to be damaged or destroyed.

At that time the Iraqis told UNSCOM that occupying coalition
troops had destroyed chemical weapons at Bunker 73 earlier that
year, that is in '91. Iraqi statements, however, were viewed with
skepticism at the time because of the broad continuous use of de-
ception by the Iraqis against UNSCOM. And UNSCOM tests for
the presence of chemical agents at Bunker 73 were negative.

In March of '92 UNSCOM inspectors returned to Kamisiyah.
There they reported that they consolidated and destroyed a total of
463 nerve agent rockets found in the pit area, including the 297
they had found previously in October.

In May of 1996, UNSCOM inspectors returned to Kamisiyah, and
for the first time did a thorough evaluation of remanants at Bunk-
er 73. They found that the rockets still remaining in and near
Bunker 73 possessed the physical characteristics of 122-millimeter
chemical rockets used by the Iraqis, and were the same t5TDe which
had been found in the pit area. It was at this time that Iraqi offi-
cials told UNSCOM for the first time that occupying coalition
forces had destroyed the rockets found in the pit area.

Now, back in early March of '91, after the Gulf War cease fire,
the 37th engineering battalion, as well as elements of the 307th en-
gineer battalion, both supporting the 82nd Airborne Division,
moved into the vicinity of Kamisiyah with a mission to destroy the
bunkers and their contents, prior to moving back to Saudi Arabia
for redeployment. During the period three to ten March '91, a sys-
tematic destruction of the Kamisiyah bunkers was conducted. Ex-
plosive ordinance disposal unit personnel supported the engineers
during this operation. All EOD members who'd been interviewed
stated that they were aware that they might encounter chemical
munitions at any ammunition site and were looking for them. At
Kamisiyah, they reportedly examined each bunker and did not
identify any chemical munitions.

Operational records, intelligence information and personal inter-
views with over 40 individuals involved in the operation, including

the battalion commander, three company commanders, has enabled
a reconstruction of the events which occurred at Kamisiyah be-
tween 2 to 10 March 1991. Elements of the 37th engineer battalion
moved into Kamisiyah area on March 2. And on March 4th, the en-
gineers destroyed 33 bunkers, one of which was Bunker 73, now
identified as containing chemical munitions in May of 1996 by
UNSCOM.

I describe the process in my prepared testimony in detail in
terms of what was blown when and what was found in the various
bunkers.

The 37th Engineering Battalion operations officer stated that on
9 March, he found an unknown number of stacks of long-crated
munitions in the pit area as distinct from Bunker 73, which cor-
responds to the location where UNSCOM teams found the damaged
122-millimeter rockets. And those pit area stacks of munitions
were destroyed on the 10th of March. I won't repeat, but I'd be
happy to talk in the question period, Mr. McLaughlin's comments
about the current CIA modeling which is going on, and what, in-
deed, they have found in their model for the Bunker 73 area and
what they will come up with in the pit area.

The 4,000 to 5,000 potentially affected troops within 25 kilo-
meters of the Bunker 73 detonation of March 4th are being notified
and advised of the availability of the DOD and VA evaluation
treatment program.

Using our geographic information system, we've identified unit
locations near Kamisiyah on 10 March — that's the date that the pit
was blown— 1991. The 3,000 to 4,000 potentially affected troops
within 25 kilometers of the pit destruction on March 10th are also
being notified and advised of our evaluation and treatment pro-
grams.

There were no chemical casualties reported during the demoli-
tion operations of either area. An evaluation of medical logs of the
units in the area did not show any increase in clinic visits or any
reports of possible chemical exposure symptoms.

In our evaluation of the reported chemical detections from the
NBC reconnaissance vehicle, the FOX vehicle, and the M256 kits,
we looked for any reports of symptoms of acute exposures to chemi-
cal agents or reports of chemical casualties among the units in the
vicinity of the reported detections — that is, not only at Kamisiyah,
but all other sites during and after the war where FOX vehicle or
M256 alarms went off.

Except for the incident of the blister agent exposure of Sergeant
David Fisher, an Army scout who went into a bunker in southern
Iraq during the war, we found none.

We then looked for any physical evidence that might indicate
that chemical agent were present in the area of the detections.
Again, we have found no evidence that would allow us to assess the
validity of any of the reported detections. That is not to say that
the detections are not valid, but simply that we have not been able
to find corroborating evidence such as physical samples.

Since during the war there were no reported chemical casualities
or symptoms of acute exposure apart from the Sergeant Fisher inci-
dent, and no physical evidence to substantiate that chemical agents
were present, we then turned our attention to the question of

whether there might have been low — below detector-sensitivity —
levels of chemical agents present.

To date, we have not been able to identify human or animal stud-
ies that have directly addressed the issue of short-term low-level
nerve agent exposure followed by chronic symptoms or disease. The
existing literature consistently indicated that in humans and ani-
mals receiving short-term exposure to agent levels which do not
produce symptoms acutely, no long-term clinical effects are found.

Once learning of the probable presence of chemical agents at
Kamisiyah, we initiated several steps concurrently to rapidly as-
sess whether health-related consequence may have occurred among
service members who demolished the bunker. With those steps un-
derway, we expanded the geographic ring from the immediate vi-
cinity of the bunker to a surrounding distance of five kilometers
and then to 25 kilometers.

During this period, further information came to light indicating
the detonation of chemical weapons in the pit at the Kamisiyah
storage site. We initiated the same steps for the pit that were un-
derway for the bunker. However, because of the nature of the deto-
nation and the larger amount of munitions at the pit site, we are
considering geographic rings of greater distances.

These are the steps, medically, that we've taken and that con-
tinue to be taken today. The demolition of the bunker itself — Bunk-
er 73 — involved approximately 150 individuals at that site. Our
first step was to review the clinical records of service members
from these involved units, who also had participated in the depart-
ment's comprehensive clinical evaluation program.

We've now signficantly broadened our review efforts to include
all members of the four units who were at Kamisiyah, plus others
known to have been in the geographic rings of five and 25 kilo-
meters of the bunker at the time of demolition. Similar reviews of
clinical records of involved service members are underway for those
who were within geographic rings surrounding the Kamisiyah pit.
And when we receive the modeling of the pit exposure zone from
the CIA, we will set those rings appropriately.

The second step was to contact individuals who were assigned to
these units personally to inform them of the details we knew thus
far, to obtain any other information regarding Kamisiyah that they
may recall and to remind them of the availability of medical eval-
uations through the VA or DOD. This investigative efforts contin-
ues and thus far over 400 individuals have been contacted by tele-
phone.

Next, we are conducting a review of information regarding DOD
hospitalizations since the Persian Gulf War accumulated by the
Naval Health Research Center to identify any unusual patterns in-
volving members of those units. Our preliminary results from the
first review reveal that there are no unusual hospitalizations.

Our next step was to conduct preliminary investigations of other
sites where there may have been the potential for exposure of U.S.
forces to chemical agents. Mr. McLaughlin has already spoken
about the two sites destroyed from the air. We are now examining
the reports of positive indicators from the FOX detection vehicles,
the M-256's and the two Czech detections. These incidents number

26 in all, including 12 Fox detections, and 12 M-256 detections,
and including the report from Al Jubayl.

We have established as a top priority and are funding as quickly
as possible expedited peer review research concerning the subject
of potential chronic effects caused from low-level exposures to
chemical agents. We've already funded three research proposals for
$2.5 million, and we're committed to funding another $2.5 million
in the next months.

Finally, we have asked the Institute of Medicine, which oversaw
our initial CCEP — Clinical Evaluation Program — to re-examine
their review of our program to determine if, in the light of the
Kamisiyah information, we should again evaluate these individuals
or to conduct further tests — whether we should alter our protocol.

Mr. Chairman, I don't know whether you want me to take more
time going back through the steps that we had taken before
Kamisiyah. I have some very strong feelings about some of the
comments that have been made about our clinical evaluation pro-
gram, which began in May of 1994. We've extensively examined
and cared for over 22,000 individuals, and that registry is on-going.
But I will respond to your questions on that, perhaps, rather than
take more time in my prepared statement.

Similarly, you will find in my prepared statement details on the
department's senior oversight panel, the Persian Gulf investigation
team formed in '94, our extensive declassification effort and the re-
search portfolio of activities that we are conducting ourselves and
in collaboration with the Veterans' Administration.

I also would leave for you to see in the prepared testimony how
some of the lessons learned from this experience in the Gulf are
now being built into our activities in other deployments, including
Bosnia, so that we have a more effective pre- and post-deployment
surveillance mechanism.

SSCI Chairman Specter. Thank

Dr. Joseph. Mr. Chairman, I'll close, if I may. May I finish my
closing statement?

SSCI Chairman Specter [continuing]. Thank you. Dr. Joseph.
Your full statement and the addenda will be included in the record
and I did not want to interrupt your testimony because there is a
lot of explaining to do and I wanted to give you a full opportunity
to do that. And you'll have further opportunity, I'm sure. There'll
be some questions.

We now turn to Dr. Kenneth W. Kizer, who is the Under Sec-
retary for Health of the Department of Veteran's Affairs, a very
distinguished academic and professional record; honors graduate of
Stanford University and the University of California; certified in
five medical specialities; author of some 300 articles, books, chap-
ters or other reports; extensive service in government, academia,
philanthropy; served for six years as director of the California De-
partment of Health Service.

The floor in yours. Dr. Kizer. To the extent that you can limit
your opening comments to five minutes, we'd appreciate it. Time is
going. We have quite a few Senators who want to question.

[The prepared statement of Mr. Kizer follows:]

Statement of Kenneth W. Kizer, M.D., M.P.H., Under Secretary for Health,
Department of Veterans Affairs

Mr. Chairman and Members of the Committees, I appear before you today to up-
date you on the Department of Veterans Affairs (VA) Persian Gulf War-related pro-
grams, with a specific focus on VA responses to the possibility, and now probability,
of low-level exposure of American troops to chemical warfare nerve agents.

In the way of background let me reiterate a few points about VA's general re-
sponse.

Shortly after returning from the Persian Gulf conflict in 1991, veterans began to
report a variety of s3Tnptoms and illnesses. In response, the Department of Veterans
Affairs developed the first of its several programs for these veterans. This was the
Persian Gulf Veterans Registry health examination program. Ever since then, the
Department has continuously tried to improve and expand its Persian Gulf War-re-
lated programs. Those programs now encompass a four-pronged approach that in-
cludes medical care, research, compensation, and outreach.

With regard to medical care, I would noted that VA provides Persian Gulf Reg-
istry Health Examinations, Referral Center evaluations, and readjustment and sex-
ual trauma counseling, as well as outpatient and inpatient care under special eligi-
bility provisions for Persian Gulf War veterans.

VA's position since the Registry's inception has been that all Persian Gulf War
veterans should participate in the Registry program. To date, more than 60,000 vet-
erans have completed Registry examinations. Almost 187,000 have been seen in VA
ambulatory care clinics, and more than 18,200 have been hospitalized at VA medical
facilities.

Persian Gulf veterans participating in the Registry examination have commonly
reported a diverse array of symptoms, including fatigue, headache, muscle and joint
pain, memory problems, shortness of breath, sleep disturbances, nausea, diarrhea
and other gastrointestinal complaints, rashes, and chest pain. Of note, 12 percent
of the Registry examinees have no health complaints but wish to participate in the
examination to establish a baseline should they develop future health problems that
might later be found to be due to their service in the Persian Gulf War.

I would reiterate again today that VA encourages all Persian Gulf War veterans,
whether symptomatic or not, to avail themselves of the Registry examination pro-
gram, especially if they are concerned about possible exposure to chemical warfare
agents in light of DoD's recent announcements. Further, we would encourage per-
sons who have been previously examined as part of the Registry program to request
a follow up examination if they have sjTnptoms or concerns.

VA has always remained open to the possibility that military personnel may have
been exposed to a variety of hazardous agents, including chemical warfare agents,
while serving in the Gulf War theater of operations.

In this regard, some Members of Congress have recently asked VA whether we
listened to veterans who reported their belief that they had been exposed to chemi-
cal warfare agents during their Persian Gulf service. We did listen to those veter-
ans. Illustrative of this, prior to the DoD announcement on June 21, 1996, VA de-
signed its clinical uniform case assessment protocol to detect clinical signs and
symptoms related to possible neurotoxic exposures. Neurologic examinations and
cognitive testing have been part of the protocol from early on. As a result of this,
VA diagnostic protocols and treatment programs do not need any substantial revi-
sion in light of DoD's recent disclosures about the release of sarin at Khamisiyah
in March 1991.

Likewise, in response to a Reserve Construction Battalion unit of PGW veterans
from Alabama, Tennessee, North Carolina, and Georgia reporting adverse health ef-
fects, which they believed were due to exposure to low-level chemical warfare
agents, VA established a pilot medical assessment program at the Birmingham VA
Medical Center to evaluate their health status. (As part of this special health care
program, more than 100 veterans were evaluated. Included in this group were 55
veterans who complained of cognitive problems; these veterans underwent extensive
(7-8 hours) neuropsychological testing and clinical evaluations. These evaluations
did not reveal the pattern of neurologic abnormalities typically associated with
neurotoxin exposure.) This pilot program evolved into VAMC Birmingham being
designated a special referral center in June 1995.

A further demonstration of the fact that we were heeding what the veterans were
sajang can be found in the National Health Survey of Persian Gulf War Veterans
where specific questions are asked about possible exposure to chemical warfare
nerve toxins and mustard gas.

At this juncture, I believe it is very important to point out that there is no bio-
marker, laboratory finding or diagnostic test for chemical warfare agent nerve toxin

40-180 97-2

exposure. The diagnosis of conditions related to nerve toxins, whether they be chem-
ical warfare agents, pesticides or hazardous industrial chemicals, is based on two
things: first, known or presumed exposure to the chemical agent, and second, symp-
toms or physical signs consistent with the known biological effects of the chemical.
Absent aefinite exposure data and/or typical symptoms and signs, it is essentially
impossible to make a definitive diagnosis of chemical-related neurotoxicity. Further-
more, there is no curative therapy for the expected neurotoxic effects of these
agents, although symptomatic treatments are available and represent the state-of-
the-art at this time.

These same problems apply to conducting research in this area. Indeed one of the
most challenging problems in conceptualizing and designing valid scientific studies
of potential long-term effects of low level exposure to chemical warfare agents is
knowing wjhat exactly one should measure and study when there were no symptoms
or signs of acute toxicity. It is clear in my mind that if we are going to adequately
research these questions a major investment will be needed to develop both the
physical plant capabilities and the intellectual capital that are required to conduct
these very difficult studies.

The results of our Persian Gulf Registry health examination program are similar
to those reported by other investigators, including scientists in England and Can-
ada. In reviewing these data, it is important to recognize that numerous scientists
and advisory committees have reviewed the medical data collected in these pro-
grams and have concluded that a wide variety of illnesses, including the whole
range of well-defined medical and psychiatric conditions, are being diagnosed among
PGW veterans. Furthermore, VA physicians have found that only a relatively small
percentage of PGW veterans have unexplained illnesses and that no single, unique
disease explains the range of the illnesses being diagnosed in Persian Gulf War vet-
erans. That is, there is no Gulf War Syndrome in the strict medical sense of the
term. In saying this, though, it is important to emphasize that VA does not at all
doubt that many veterans reporting unexplained illnesses are suffering from real ill-
ness, and some are seriously ill, and that the inability to make definitive diagnoses
is very frustrating for our physicians and other practitioners,as well as our veteran
patients.

We continue to search for answers, and we continue to strive to expand our under-
standing of the illnesses of Persian Gulf veterans. And while scientific answers are
being sought through research, VA will continue to provide needed healthcare and
other services, including disability compensation, for those veterans suffering from
either diagnosed or underdiagnosed illnesses.

With regard to research, I would remind you that the Registry and other similar
examination program data are provided through medical records of self-selected in-
dividuals and, thus, may not be reflective of the entire population of Persian Gulf
War veterans. In order to draw definitive conclusions about the health status of
PGW veterans, a carefully designed and well-executed research program is nec-
essary. VA has initiated such a research program.

VA's research program related to Persian Gulf veterans illnesses includes more
than 30 individual projects being carried out by VA and university-affiliated inves-
tigators across the nation. And these projects are but part of the overall federal re-
search effort.

VA established three Environmental Hazards Research Centers in 1994; all three
centers are carrying out projects which address aspects of the potential adverse
health outcomes of exposure to neurotoxins. In addition, VA's Environmental Epide-
miology Service has completed a Persian Gulf Veterans Mortality Study and the
first phase of the National Health Survey of Persian Gulf War Veterans and their
Families. Details of these and other Government Federally sponsored research stud-
ies are included in the report, "Federally Sponsored Research on Persian Gulf Veter-
ans Illnesses for 1995." Copies of this report have been provided to the Committees.

In May, VA announced that it would establish a fourth Environmental Hazards
Research Center. This center will study adverse reproductive health effects that
may be associated with military occupational exposures in the Persian Gulf, Viet-
nam and elsewhere. The proposals were due to VA's Research and Development
Service on September 16, and awards will be made in the next two months.

I would take this opportunity to also give you a status report on the progress of
two major epidemiological efforts.

The first is the Persian Gulf War Veterans Mortality Study. This study analyzes
the specific causes of all deaths among the 696,562 Persian Gulf veterans who
served in the theater of operations between August 1990 and April 1991, and a com-
parison group of 746,291 veterans who served elsewhere. The follow-up period for
this study went through September 1993. The Persian Gulf Veterans Mortality
Study has been completed and has been accepted for publication in a major sci-

entific journal. While the study demonstrates an excess in deaths in PGW veterans
due to external causes, such as automobile accidents, it does not demonstrate dif-
ferences in death rates due to medical conditions, including deaths due to cancer.
The results of this, and other scientific studies taken together, suggest that PGW
veterans as a group are not suffering from life-threatening medical conditions at
rates higher than veterans who did not serve in Operations Desert Shield and
Desert Storm.

The second study is the National Health Survey of Persian Gulf Veterans and
their FamiUes. This is being carried out by the VA's Environmental Epidemiology
Service. Phase 1, a postal survey of 15,000 Gulf War veterans and a comparison
group of 15,000 Gulf era veterans, was completed in August. The questions on this
survey asked veterans to report health complaints, medical conditions, and a wide
variety of possible environmental exposures, including episodes of potential nerve
gas, mustard gas, or biological warfare exposure. The response rate for Phase I of
this survey was 57 percent. Phase II will consist of 8,000 telephone interviews and
a review of 4,000 medical records. Phase II will address the potential for non-re-
sponse bias, provide a more stable estimate of prevalence rates for various health
outcomes, and verify self-reported health outcomes in medical records. The Phase
III examination protocol is being finalized and examinations of veterans and their
family members are expected to begin in Spring 1997. The protocol is being re-
viewed to determine if revisions are indicated based on our new knowledge of poten-
tial low-level chemical warfare agent exposures. Peer-review is being provided by a
subcommittee of VA's Persian Gulf War Expert Scientific Advisory Committee. It is
too early to discuss the results of this study as we have just begun our analysis of
the Phase I results.

In January 1994, the Secretaries of VA, DoD, and HHS established the Persian
Gulf Veterans Coordinating Board to provide interdepartmental coordination and di-
rection of federal programs related to Persian Gulf War veterans. The Coordinating
Board provides an interdepartmental means to share information on Persian Gulf
War veterans health, to effectively allocate available resources, and to provide
means of disseminating new research information. The Coordinating Board has
three primary objectives:

To ensure that all veterans are provided the complete range of healthcare services
necessary to take care of medical problems that may be related to deplo3Tnent in
Operations Desert Shield and Desert Storm;

To develop a research progreim that will result in the most accurate and complete
understanding of the health problems experienced by PGW veterans and the factors
that have contributed to these problems; and

To develop clear and consistent guidelines for the evaluation and compensation
of disabilities related to Persian Gulf service.

VA plays a central role in the Persian Gulf Veterans Coordinating Board through
its participation in the CUnical, Research, and Compensation and Benefits Working
Groups. In particular, the research working group provides guidance and coordina-
tion for VA, DoD and HHS research activities related to Persian Gulf War veterans
health. It coordinates all studies conducted or sponsored by these departments to
prevent unnecessary duplication and to ensure that important gaps in scientific
knowledge are identified and addressed. The working group is actively involved in
directing resources toward high priority questions and monitoring the results of
Federally-sponsored research projects. It has produced two reports: the "Report of
Federal Research Activities Related to Persian Gulf Veterans Illnesses" and the
1995 document "A Working Plan for Research on Persian Gulf Veterans Illnesses."
The 1996 update of the Working Plan was due to be released in September but will
be delayed to allow incorporation of this new information.

One example of the Coordinating Board's proactive role in relevant research ad-
ministration was its prioritization of the federal government and non-government
research proposals submitted for funding to DoD's Broad Agency Announcement.
The American Institute for Biological Science (AIBS) performed peer-review of the
111 proposals submitted. The research working group reviewed those proposals
judged scientifically meritious by AIBS and prioritized them according to relevance
and potential to fill research gaps in the existing Persian Gulf research portfolio.
Twelve research projects encompassing the areas of reproductive outcomes, toxi-
cology of pyridostigmine bromide, modeling of respiratory toxicant exposures from
tent heaters, psychological outcomes, leishmaniasis, chronic fatigue, fibromyalgia,
and neuromuscular function were given high priority for funding by the research
working group.

Important to note is the fact that studies of low-level chemical warfare agent ex-
posure were not given priority in the 1995 Working Plan or other research questions

because military and intelligence sources had repeatedly stated that there had been
no use, presence, or evidence of exposure to chemical warfare agents. Based on those
repeated assertions, combined with a lack of clear cut clinical evidence to support
a finding of chemical warfare exposure, the Coordinating Board focused its research
resources on other questions. This decision was supported by the Institute of Medi-
cine, VA Persian Gulf Expert Scientific Committee, the National Institutes of
Health Technology Assessment Workshop, and others.

When DoD made its recent announcement regarding possible exposure of U.S.
troops to chemical warfare nerve agents at Khamisiyah the Coordinating Board im-
mediately began revision of its action plan.

VA, through the Research Working Group of the Coordinating Board, has devel-
oped an action plan to address possible long-term health consequences of low-level
exposure to chemical warfare toxins and mustard gas, based on the DOD's an-
nouncements regarding the demolition of a chemical munitions bunker and the de-
struction of a pit containing sarin and cyclosarin at Khamisiyah.

A recent literature review carried out by the Armed Forces Epidemiology Board,
an advisory board of independent, non-government scientists, suggests that readily-
identifiable, long-term adverse health effects due to nerve agent exposures only
occur in human who show signs of acute toxicity or poisoning. That, is the available
literature does not contain clear evidence that long-term, chronic adverse health ef-
fects result from exposures that do not produce acute clinical signs and symptoms.
However, I should note that the research in this area is sparse and in VA's judg-
ment it should not be construed to mean that clinically important adverse health
effects cannot or definitely do not occur in the setting of low-level neurotoxin expo-
sures. The Coordinating Board has recommended that more research resources be
allocated to address this question. I strongly agree with this approach.

The DoD announcement regarding the demolitions at Khamisiyah has caused VA
to reconsider and intensify its efforts related to possible effects of low-level expo-
sures to chemical warfare agents. I have asked the Research Working Group of the
Coordinating Board to provide a plan for addressing this issue as a component of
the 1996 Working Plan for Research. As it now stands, the research working group
has recommended a plan of action to: (1) fund toxicological research proposals on
low-level chemical weapons exposure from a pool of already peer-reviewed proposals
that had been submitted through a competitive process to the Army; (2) solicit re-
search on the feasibility of conducting epidemiological investigations of low-level
chemical agent effects; and (3) review the ability to confirm the identities and loca-
tions of individuals in and around Khamisiyah with the goal of soliciting, if appro-
priate, an epidemiological investigation.

Based on the Coordinating Board's recommendation, $2.5 million dollars has al-
ready been allocated to three new, peer-reviewed, basic science research projects in
this area, and an additional $2.5 million dollar has been identified for future stud-
ies. Funding for these new efforts will come from the DoDA^A collaborative research
program that is funded as part of DoD's appropriation.

While these efforts represent a good beginning, I have asked VA's Research and
Development Service to take a completely fresh and broad look at these issues in
light of the new information now provided by DoD. This includes asking them to
develop a strategic plan for an environmental health research agenda that specifi-
cally focuses on low-level exposures to neurotoxins that might result from chemical
warfare agents or other military situations. Likewise, we are in the process of orga-
nizing an international scientific symposium that bridges potential military and ci-
vilian incidents involving exposure to those types of chemicals. Given the relative
lack of worldwide scientific capability for assessing these issues in the traditional
open and peer-reviewed manner in which the best science is carried out, we believe
it is essential to bring together a multi-disciplinary group of experts to focus on find-
ing innovative solutions to these perplexing issues. In this regard, I would again
stress that if we are going to adequately research these questions, a major invest-
ment of resources will be needed.

In conclusion, I would reiterate that research related to the illnesses of Persian
Gulf War veterans is highly complex, and this is especially so for the investigation
of concerns related to possible low-level exposure to chemical warfare agents. VA is
committed to meeting these challenges and obtaining the most accurate answers we
can concerning the health of PGW veterans and their families. In this regard we
are grateful for the assistance provided by the Presidential Advisory Committee on
Gulf War Veterans' Illnesses, particularly insofar as the Committee played a central
role in bringing to light this new information about probable troop exposure to sarin
and cyclosarin.

Thank you, Mr. Chairmen. That concludes my prepared testimony.

STATEMENT OF DR. KENNETH W. KIZER, UNDER SECRETARY
FOR HEALTH, DEPARTMENT OF VETERANS AFFAIRS

Dr. KiZER. Thank you. Good morning, Mr. Chairman, Members
of the Committee.

I'd Hke to take these few minutes for an opening statement to
comment on the Department of Veterans' Affairs' Persian Gulf-re-
lated programs, focusing especially on VA's responses to the recent
reports about the probable low-level exposure of American troops to
chemical warfare agents. And I will do my best to keep within the
five minutes that you noted.

SSCI Chairman Specter. Thank you.

Dr. KiZER. A number of Senators have already commented this
morning about VA's multi-pronged effort to provide medical care,
to conduct research, to provide compensation and to outreach to the
Persian Gulf veterans. VA's position since the inception of the Per-
sian Gulf Registry in 1991 has been that all Persian Gulf veterans
should participate in the registry program. I would today again re-
iterate that VA encourages all Persian Gulf veterans, whether
symptomatic or not, to avail themselves of the registry examination
program, especially if they are concerned about possible exposure
to chemical warfare agents in light of DOD's recent announce-
ments. Further, we would encourage persons who have previously
been examined as part of the registry program to request a follow-
up examination if they have symptoms or concerns.

I'd also take this opportunity to underscore, as we have at a
number of other forums, that the VA has always remained open to
the possibility that military personnel may have been exposed to a
variety of hazardous agents, including chemical warfare agents,
while serving in the Gulf War theater of operations. In this regard,
I would note that a number of Members of Congress have recently
asked whether the VA listened to the veterans who reported their
belief that they had been exposed to chemical agents during the
Persian Gulf service, and I would affirm, as we have, that we did
listen to those veterans. Illustrative of this prior to DOD's an-
nouncement at the end of June this year, VA had designed a clini-
cal uniform case assessment protocol to detect clinical signs and
symptoms related to possible neurotoxic exposures, and neurologic
examinations and cognitive testing have been part of the protocol
from early on.

I would also add, as an aside, that as a result of this, the VA's
diagnostic protocols and treatment programs do not need any sub-
stantial revision in light of DOD's recent disclosures, although we
are taking another look at this.

Just a couple of other things I might note in this regard — when
the reserve construction battalion unit of Persian Gulf veterans
from Alabama, Tennessee, North Carolina and Georgia reported
adverse health effects that they believed were due to low-level
chemical warfare agents, we established a pilot medical assessment
program at the Birmingham VA Medical Center to evaluate their
health status. That was subsequently turned into a major referral
center.

Further, as evidence that we were heeding what the veterans
themselves were sajdng is that in the National Health Survey of
Persian Gulf veterans, which Senator Simpson commented about

this morning, specific questions are asked about possible exposure
to chemical warfare nerve toxins, as well as mustard gas.

At this point, I think it is very important to point out a couple
of things. There is no biomarker, laboratory finding or diagnostic
test that can be conducted for chemical warfare agent nerve toxin
exposure. The diagnosis of conditions related to nerve toxins,
whether they occur as a result of chemical warfare agents, whether
they occur as a result of agricultural pesticides, or whether they
occur as a result of hazardous industrial chemicals, is based on two
things. First, the known or presumed exposure to the chemical
agent, and second, sjonptoms or physical signs consistent with the
known biological effects of the chemical. Absent definite exposure
data or typical signs and S3anptoms, it is essentially impossible to
make a definitive diagnosis of chemical related neurotoxicity.

These same problems apply to conducting research in this area.
Indeed, one of the most challenging problems that we have in con-
ceptualizing and designing valid scientific studies of potential long
term effects of low level exposure to chemical warfare agents is
knowing what exactly one should measure and study when there
were no signs or symptoms. It's very clear in my mind that if we're
going to adequately research these questions, a major investment
will be required to develop both the physical plant capabilities and
the intellectual capital that are required to conduct these very dif-
ficult studies.

Now, in the interest of time let me move forward to make a few
comments about the research programs that are underway. Again,
Members have already commented about the number of studies
being conducted by VA and other agencies. I think it is important
to note at this junction that studies of low level chemical warfare
agent exposure were not given as high priority as other research
areas in the previous working plans of Persian Gulf veteran ill-
nesses because military and intelligence sources had repeatedly
stated that there was no use, presence or evidence of chemical ex-
posure, or of exposure to chemical warfare agents. Those repeated
assertions, combined with a lack of clear cut clinical evidence to
support a finding of chemical warfare agent exposure, resulted in
the Persian Gulf Veteran Coordinating Board focusing its research
resources on other questions. And that decision was supported by
the Institute of Medicine, the VA Persian Gulf Expert Scientific
Committee, the National Institute of Health Technology Assess-
ment Workshop and others.

As a result of the recent announcements regarding probable ex-
posure at Kamisiyah, the Coordinating Board immediately began a
revision of its plan. The VA, through the Research Working Group
of the Coordinating Board, has developed an action plan to address
possible long-term health consequences of low-level exposure to
these chemical warfare nerve toxins and mustard gas based on the
new information.

And let me just state again, in the interest of time, that Dr. Jo-
seph, I think, has commented about the conventional medical
thinking today that long-term adverse health affects due to nerve
agent exposure only occur in humans who show signs of acute tox-
icity. However, I would caution that the research in this area is
very sparse and that in VA's judgment it should not be construed

to mean that clinically important adverse health affects cannot or
do not occur in the setting of short-term, low-level exposures, espe-
cially, if it's combined with other environmental stressors. The Co-
ordinating Board has recommended more research be done in this
regard, and I strongly support that approach.

Just a few other details in this regard. The Research Working
Group has moved forward on a plan — to pursue action in this re-
gard. As it now stands, the Research Working Group has rec-
ommended funding three toxicologic research proposals on low-level
chemical weapons exposure from a pool of already peer-reviewed
proposals that have been submitted through a competitive process.
They're going to solicit research on the feasibility of conducting epi-
demiologic investigations of low-level chemical agents, and like-
wise, review the ability to confirm the identities and locations of in-
dividuals in and around Kamisiyah with the goal of soliciting fur-
ther epidemiologic investigation if it's appropriate.

And while these things represent a good beginning, I've asked
VA's Research and Development Service to take a completely fresh
and broad look at these issues in light of the new information now
provided by DOD. This includes asking them to develop a strategic
plan for an environmental health research agenda that specifically
focuses on low-level exposures to neurotoxins that might result
from chemical warfare agents or other military situations. Like-
wise, we're in the process of organizing an international scientific
symposium that bridges potential military and civilian incidents in-
volving exposure to these type of chemicals. Given the relative lack
of worldwide scientific capability for assessing these issues in the
traditional open and peer reviewed manner in which the best
science is conducted, we believe that it's essential to bring together
a multi-disciplinary group of experts to focus on finding innovative
ways to solve these perplexing problems.

In this regard, I would again stress that if we're going to ade-
quately research these questions, a major investment of resources
will be needed.

Let me just conclude these comments by reiterating that the VA
is committed to meeting these challenges and obtaining the most
accurate answers we can concerning the health of our Persian Gulf
veterans and their families. In this regard, we are grateful for the
assistance provided by Congress, as well as, certainly, the White
House, especially as manifested through the Presidential Advisory
Commission on Persian Gulf War Veterans Illnesses and the very
central role they have played in bringing this new information
about probable troop exposure to light.

With that let me stop and thank you for this opportunity to make
these comments.

SSCI Chairman Specter. Thank you very much. Dr. Kizer.

Dr. Joseph, I begin the first question with you. We have the de-
struction of a chemical weapons site in March of 1991. In October
of 1991, you have an identification, clear cut, of its being a chemi-
cal weapons site. You have the deputy director of defense saying,
today, quote, "At this time, we do not know if U.S. troops were ex-
posed to toxic chemicals during these events." Isn't the Department
of Defense, really, AWOL and derelict in not facing up to the De-
partment of Defense's responsibility in this matter as of today?

Dr. Joseph. I don't believe the Department is AWOL or derelict,
Mr. Chairman. I think, as I read the Deputy Secretary of Defense's
words this morning, he uses them in the same sense that Senator
Simpson did. We do not know. I think everyone has said — the De-
partment has said — since Mr. Bacon, a spokesman, on June 21st
was the Kamisiyah announcement — that we think now that it is
highly probable or plausible that there was an exposure to agent
by that demolition team.

Whether we know that yet or not, I think, is another story. And
particularly, whether we know that yet or not in the sense of a
level of exposure to toxic substance that might be thought to have
health effects.

SSCI Chairman SPECTER. Well, Dr. Joseph I have to disagree
with you when you say plausible or highly probable. How much
time is it going to take to have an assessment as to the responsibil-
ity of the Department of Defense? You have Dr. Kizer's reference
to the Presidential advisory commission. The investigators for that
advisory commission said that the credibility of the Defense De-
partment had been gravely undermined by its activities here. Do
you disagree with that?

Dr. Joseph. Well, we'll see what the commission, itself, says.

In fact, Mr. Chairman, as I think ought to be clear from Mr.
McLaughlin's testimony and mine, it was the rediscovery by the
CIA and the DOD in light of the UNSCOM May '96 report that
surfaced Kamisiyah. Kamisiyah is an important watershed inci-
dent. We don't disagree with that at all. But it was the CIA and
DOD in Hght of the May '96 UNSCOM report that resurfaced
Kamisiyah. And in fact, it was the DOD who announced that find-
ing, not the Presidential advisory committee.

SSCI Chairman Specter. Well, why do we need a rediscovery
and a redefinition, when you have an October 1991 determination
that Kamisiyah was a chemical weapons site? And you have an
elaborate sequence to find — described by the CIA, here in testi-
mony today, all of which you knew about long ago, so that you have
what really amounts to stonewalling, not to use excessive pejo-
ratives — pretty hard to find an excessive pejorative, really — with
the Secretary, the Deputy Secretary of Defense saying that we do
not know if U.S. troops were exposed to toxic chemicals during
those events. I mean, isn't conclusive, definite, established, proved,
that U.S. troops were exposed to toxic chemicals?

Dr. Joseph. I'd like to give an answer in two parts to that, Sen-
ator.

First, I think

SSCI Chairman Specter. Were either of those parts yes or no?

Dr. Joseph. Yes, they are.

SSCI Chairman Specter. Okay.

Dr. Joseph. The answer to the first part is no, that I don't be-
lieve the Department is stonewalling. I think it's amply dem-
onstrated in my testimony that we are treating Kamisiyah pit,
Kamisiyah bunker, the other FOX and 256 detections and the
Czech detections as instances of probable exposure. And that we
are treating them from the investigational side and the medical
side as if these are incidents of exposure.

SSCI Chairman Specter. Well, you talk about as if, and you talk
about probabilities, but your conclusion is from your treatment,
that U.S. troops were exposed to toxic chemicals during those
events. That's what you're saying. You're treating them

Dr. Joseph. As if they were. Yes, sir.

SSCI Chairman Specter. As if.

Dr. Joseph. Yes, sir.

SSCI Chairman Specter. Well, the conclusion is that they were
exposed, because that's why you're treating them. I mean, what's
the point, Dr. Joseph, in the business as if? You have the testimony
of Dr. Kizer, which you don't have to be credentialed, as you men
are — extraordinarily so — that a diagnosis of nerve toxins depends
on base of exposure and symptoms. And you have both of those fac-
tors there. And you're treating them.

So isn't it really a pretty common sense conclusion that the U.S.
troops were exposed to toxic chemicals during those events?

Dr. Joseph. Mr. Chairman, you've made — I think there's one
error of logic in the statement you've just made. We do not have
evidence of symptoms at the time of demolition. As Dr. Kizer said,
and I said in my testimony, the current scientific knowledge — im-
perfect as it may be — and I totally agree with what he said, and
what I said about our need to get on and improve that knowledge —
is that in the absence of acute s3rmptoms to low-level exposure, the
current scientific opinion is that there are not chronic symptoms.
What we have is a high probability, plausibility of exposure, no un-
derstanding of acute symptoms at the time, now symptoms later —
chronically later, several years later — and the question remains,
are those symptoms related to that probable exposure at low level
five years earlier? And I would submit that we do not know the an-
swer to that question, and we are doing everything we can to find
out.

SSCI Chairman Specter. Well, my time is up. And I shall not
ask any more questions, but I do conclude by sa3ring that you are
treating as if, but that to me sounds like legalese for accepting the
responsibility. And that the essence of what you're saying is that
you're treating because these troops were exposed to toxic chemi-
cals during those events. And when you talk about not contempora-
neously knowing that the symptoms existed, you weren't there to
inspect them contemporaneously with the event to see what the
sjonptoms were, and there has to be an inference made after the
fact. And it seems to me that five years after the event, that the
Department of Defense and you, Dr. Joseph, would be well advised
and certainly the Deputy Secretary not to say we do not know if
U.S. troops were exposed on this face of the record.

Senator Simpson.

Veterans' Chairman SiMPSON. Thank you, Mr. Chairman, my fel-
low chairman.

I was in the Army. I was never in combat, very few of us were.
I think the figure is of the 26 million of us who are veterans, per-
haps 3 million of us were exposed to combat or even in a combat
theater. As I wind down 18 years of this work, I find that the most
vigorous activity comes from frustration, irritation, impatience and
anxiety, because it takes time to get medical and scientific an-
swers. Time is not what anybody wants. They want immediacy.

And I think everything in America is based on immediacy. Right
now. Gratification. You name it. We want it now, whether it's
consumer goods or other things. This is a tough issue.

I do remember the training that we were exposed to certain pla-
cebos and fake gases — and we were supposed to respond. Some-
times that was to perform a self-inoculation with a little syringe
crammed into your calves. There were guys who said even if they
smelled the stuff, they wouldn't do that, because they were fearful
of sticking a needle in themselves. It was interesting stuff as I
watched all that.

I do know enough about nerve gas, at least through my training
many years ago at Fort Benning and in Germany, that if somebody
were exposed to that stuff, there is an immediate symptom. It's
called death. Is that not correct?

Dr. Joseph. There are degrees of symptoms, but

Veterans' Chairman Simpson. I know, but one of them is

Dr. Joseph. Yes, sir.

Veterans' Chairman Simpson. And then there is suffocation, and
there is respiratory failure, there is congest — there are many
things when somebody gets a whiff of that stuff. Is that not cor-
rect?

Dr. Joseph. That is correct, Mr. Chairman, and that's why we
went back and looked at the unit medical logs and reports — looked
for any reports of acute symptoms, illness or death in the areas of
the demolition. And as I said in my testimony, we have not found
them.

Veterans' Chairman Simpson. And there were about 150 of these
men on the ground — or what was that figure — that were part of the
detonation team?

Dr. Joseph. Well, Senator Simpson, I think that's part of the
confusion here, what the number is. What I tried to do in my testi-
mony is talk about how many were at which distance from which
demolition. You are correct in terms of the actual site of the demo-
lition, of the bunker, sir.

Veterans' Chairman Simpson. Well, obviously we would all know
medically and scientifically that high-level exposure would have
been dramatic and hideous. Low-level exposure less so, but how
less so? But what we do know is that no one at the site while doing
that work expressed any discomfiture. Is that where we are?

Dr. Joseph. That is the best information we have.

Veterans' Chairman Simpson. That is what we know.

Dr. Joseph. That is what we know.

Veterans' Chairman Simpson. And those are interviews of those
people, is that not correct?

Dr. Joseph. That's correct.

Veterans' Chairman Simpson. Personal interviews?

Dr. Joseph. Personal interviews, and going back, looking at the
medical logs, talking to the battalion commander and the company
commanders, yes, sir.

Veterans' Chairman Simpson. Okay. I heard that. You named
two or three company commanders in the battalion. After the mis-
sion was completed and the detonation and the bunker savagery
was done, no one in that unit complained of any effects at all that
would indicate anything. Is that correct?

Dr. Joseph. That is correct.

Veterans' Chairman Simpson. Were there any chemical detec-
tors? It seems hke a unit Hke that would have one on every — one
on every shoulder. One on their belly, one on their ear. What did
they have with regard to chemical detectors?

Dr. Joseph. In my testimony, in my prepared testimony, Sen-
ator, I go to some detail about the issue of what detectors were at
the Kamisiyah bunker and pit sites and what occasioned. Initially,
the information we had that there were no positive detections,
there have been some changes of story. One, for example, one per-
son now says that his M-256 kit was positive — was weakly posi-
tive.

Veterans' Chairman SiMPSON. Describe what each of these men
carried because they knew that they were in an area of possible
nerve gas and other agent presence.

Dr. Joseph. I want to preface that by saying that, of course, it's
not all one activity and one group of people.

Veterans' Chairman Simpson. I understand.

Dr. Joseph. The initial entry into the bunker site — let me speak
about the bunker site. The initial entry into the bunker site in-
cluded the activity of NBC — nuclear, biological, chemical — person-
nel who were to look for any evidence of weapons of mass destruc-
tion. As Mr. McLaughlin has said in his testimony, on that initial
bunker investigation they did not see any. They, of course, would
have with them both the first level MlAl, sort of least effective,
or most sensitive and least specific, warning kit. Then they would
be followed by the EOD, the demolitions team itself, who would go
in and who would have with them that kit plus the M256, which
is a more specific kit. We did not have FOX vehicles in that area.

Now, there is a question as to whether there was — I believe there
was one MlAl alarm that went off. And in response to that, de-
pending on who you talked to who was there that day, some of the
members of the 37th did put on their protective gear, some did not
put on their protective gear. We don't have a verification about a
second-level detector that would confirm the first. And in all that
we know, when the actual explosion occurred, the members of the
37th who had been at the site, laid the charges, had moved off
about three kilometers or three miles from the site. And they were
not in protective gear. There is a videotape that you may have seen
that shows them not in protective gear.

Veterans' Chairman SiMPSON. Well, my time has expired. But
when it was all finished, everything you have said just now you've
stated before

Dr. Joseph. Yes. I beheve-

Veterans' Chairman SiMPSON [continuing]. Somewhere?

Dr. Joseph. Yes. I believe that's been said before.

Veterans' Chairman SiMPSON. I mean, how many

Dr. Joseph. Not in this detail, but

Veterans' Chairman SiMPSON. How many years ago, or how
many months ago, did you first say these things?

Dr. Joseph. Well, this was not in our awareness until June of
this year.

Veterans' Chairman SiMPSON. That's right. It could not have
been, could it?

Dr. Joseph. I believe it well, whether it could not have been

is a difficult question to ask. And I don't know whether this is the
point you want me to go back into what happened in all those in-
stances. I'd be happy to do it as the reports came in. But it was
not; it was not in the Department's awareness, nor in the CIA's
awareness until it came together in June of this year. And we an-
nounced it.

Veterans' Chairman Simpson. Because you might have had a lot
of trouble believing the Iraqis at that time was another reason
back then.

Dr. Joseph. Questions about whether the Iraqis were telling the
truth, issues about different channels intelligence and medical —
different perspective on what we were looking for back in '91, et
cetera.

Veterans' Chairman Simpson. I know one thing. My predecessors
here took care of my veterans and my successors will take care of
the veterans. That's what I know about the United States of Amer-
ica and that's what I know about the Veterans' Affairs Committee
that has endured all sorts of Administrations and all sorts of lead-
ership. That includes my partner to my right and my partner to my
left. One of them will take it over. Al Cranston, Strom Thurmond,
Frank Murkowski and others down through the years have taken
care of our veterans.

SSCI Chairman Specter. And Alan Simpson.

Veterans' Chairman Simpson. Yes, we'll I've done a little of that
too, although I get tangled up with them sometimes.

Thank you.

SSCI Chairman Specter. Thank you very much, Mr. Chairman.

Senator Kerrey.

SSCI Vice Chairman Kerrey. Thank you, Mr. Chairman.

Dr. Joseph and Mr. McLaughlin and Dr. Kizer, I appreciate very
much your testimony, particularly the written testimony, there is
a lot of detail in there. And as I — Dr. Joseph, your closing two
paragraphs I think are more important to note. Particularly, the
last one where you say that regardless of how we unravel all of this
and how we assess blame or not blame, how we figure it all out,
that the program that this Administration has established out of
nothing will provide us with a basis for evaluating, first of all,
health status of troops prior to deployment. Secondly, an evaluation
of health risks in a deployment area. And thirdly, evaluate the
health status coming out of a deployment. Is that not correct? I
mean, do you see this program as having been, you know, been
started by the President as an effort to get to the bottom and deter-
mine whether or not there is a connection between observed health
problems, very real observed health problems, and deployment it-
self? Coming out of that evaluation, though, you see something as
being produced that will be useful for future deployment.

Dr. Joseph. Well, I certainly believe that. I think it is an unprec-
edented effort that's been made. But I would not want to leave the
impression at all that we do not see Kamisiyah as an important
watershed change. Kamisiyah is a major change in the way we un-
derstand what may have happened in the Gulf, what happened in
the Gulf and what the possibility consequences may have been.
Prior to Kamisiyah, we had a number of Gulf War veterans who

were ill and we sought explanations for those illnesses. Now we
have evidence of possible, I would say plausible, chemical warfare
agent exposures and we have to go back and look at all that clini-
cal and other work we've done in light of those new disclosures and
in light of that new understanding. And I think that's what Sec-
retary White is attempting to say in his letter to Senator Thur-
mond, whatever the choice of specific words.

SSCI Vice Chairman Kerrey, well, Mr. McLaughlin, it seems to
me that as I look at the events on the 2nd through the 10th of
March and maybe. Dr. Joseph, your detailed evaluation of that or
description of that moment in your testimony could cause you to
comment on it as well. But it seems like the 37th Engineers who
went in there, along with a unit of EOD people — I don't know
about them — both of which were attached to the 82nd Airborne, is
that correct?

Dr. Joseph. In support of, yes.

SSCI Vice Chairman Kerrey. They were in support of the 82nd
Airborne. It looks, given all of the open statements that were made
about the Iraqis with chemical and biological weapons, it looks like
a pretty sloppy operation. I mean, my God, they. A, they didn't
take enough charge in there to blow up all the weapons. They left
weapons undestroyed. B, from the description that I got, that they
set the charge and they had rocket fragments falling all around
them. And C, it doesn't seem to me that they went in there with
the proper amount of attention being given, the possibility, in any
of these bunkers that the unmarked rockets — in this case a 122-
millimeter rockets — and I don't know how much sarin there is in
that weapon, but I presume that it's a sufficient amount of sarin
that if it were to come down and detonate on one of these individ-
uals who were blowing it, it could have produced the s3rmptom that
Senator Simpson was describing, which is death.

Did we have intelligence that indicated that these, contrary to
the public statements at the time, which were that the Iraqi weap-
ons were marked — did we have intelligence at the time to provide
our troops that the Iraqi sarin and mustard weapons were not
marked?

Mr. McLaughlin. We did not know at the time that these weap-
ons were at Kamisiyah, but we had issued a bulletin saying that
for the benefit of all inspectors and troops who were associated
with CENTCOM, that there was a danger of encountering un-
marked chemical weapons from Iraq. So that bulletin was out
there.

SSCI Vice Chairman Kerrey. Mr. McLaughhn, a 122 millimeter
rocket would come to your shoulder, right?

Mr. McLaughlin. Right.

SSCI Vice Chairman Kerrey. And the business end would be
about like this? And again, I don't know how much sarin is inside
of that thing.

Mr. McLaughlin. About eight kilograms.

SSCI Vice Chairman Kerrey. How much?

Mr. McLaughlin. Eight kilograms.

SSCI Vice Chairman Kerrey. Eight kilograms, which is a little
shy of four pounds of sarin. How much — you know, if I set off four

pounds of sarin inside this room would it kill everybody in the
room?

Mr. McLaughlin. Kill everybody in a much larger radius than
this room.

SSCI Vice Chairman KERREY. So I'm dealing with a — pardon me?
Eight kilograms is four pounds?

Mr. McLaughlin. No, 20.

SSCI Vice Chairman Kerrey. 20 pounds?

Mr. McLaughlin. 2.2.

SSCI Vice Chairman Kerrey. Yes, 8 times 2.2. Okay, sorry. I
flunked another test. I can spell potato, though.

[General laughter.]

SSCI Vice Chairman KERREY. It seems to me, though, you've got
a substantial risk to these troops. I mean, if 20 pounds of sarin will
kill everybody in this room and then some, and you're saying, Mr.
McLaughlin, that the intell at the time was that they were un-
marked

Mr. McLaughlin. Yes, that's correct.

SSCI Vice Chairman Kerrey. It seems to me that the 37th engi-
neer and the EOD people that accompanied them were given pretty
bad order. Somebody sitting up at the top of the food chain must
not have assessed this thing correctly. They put them — they put
those troops at substantial risk, did they not?

Mr. McLaughlin. Senator Kerrey

SSCI Vice Chairman Kerrey. I mean, let's say that's Bunker 73
sitting over there right now. Knowing what we know about what
was in those warheads, how would you feel about going over and
lashing up some charges to them and walking back about 100 me-
ters and kind of hunkering down? Which is basically what I under-
stand they did. And, you know, fire in the hole and let it go. All
of a sudden I've got, you know, falling out of the sky — geez, I've got
fragments falling on me. How would you feel about going out there
today? Wouldn't you say that give the risk that that was an inad-
visable operation?

Dr. Joseph. Well, Senator Kerrey, I think you would understand
more than most how much was going on in the area at the time.
One of the senior Army leaders who was there described to me
blowing one ammunition depot that was the size of the Washington
mall with hundreds of ammunition bunkers in it. And that was
only one among I don't know how many ammunition depots that
were blown.

SSCI Vice Chairman Kerrey. If you don't mind just stopping
right there, I mean, now you've sized the thing pretty impressively.

Mr. McLaughlin. This is a different site, sir.

SSCI Vice Chairman Kerrey. I understand, but that site you
just described could have been 100% sarin, could it not, Mr.
McLaughlin? That entire site could have been 100 percent sarin.

Mr. McLaughlin. Theoretically, but we do — from what we know
of chemical weapons in the Kuwait theater of operations, we were
only aware of chemical weapons stored at these two facilities that
we've documented here — Kamisiyah and the other.

SSCI Vice Chairman Kerrey. Thank you, Mr. Chairman.

SSCI Chairman Specter. Thank you very much. Senator Kerrey.

Senator Rockefeller?

Veterans' Ranking Member Rockefeller. Mr. Chairman, I have
actually about seven questions that I would really like to have an-
swered. I'll probably only have a chance to ask one or two in the
first round.

SSCI Chairman Specter. Go ahead.

Veterans' Ranking Member Rockefeller. Will there be a second
round?

SSCI Chairman Specter. Take what time you need.

Veterans' Ranking Member Rockefeller. Okay. Thank you sir.

Dr. Joseph, I'm particularly interested in your statement that the
DOD didn't pay too much attention to the early reports of chemical
exposures because you questioned, quote, "How could you possibly
have known that the soldiers would come home with these ill-
nesses?" close quote. To me, that's an amazing statement. You're
basically saying it's okay that somebody ignored reports of chemical
releases because we didn't have any soldiers who were sick from
them yet.

It seems to me that the job of the person in your office is to an-
ticipate these very issues, based on the best available evidence. So,
let's just look at what we did know for a second.

We did know that chemical nerve agents were in the Gulf.

We did know, or strongly suspect, that Saddam Hussein had
used nerve agents against his own people.

We did know that DOD was prescribing an experimental drug,
pyridostigmine bromide, PB, itself a nerve agent, for use by our sol-
diers, and as it turns out, for the most part without their consent.

We did know that DOD's own research suggested that PB might
effective for use against soman but not against sarin. We knew
that. You know that.

Dr. Joseph. Not me, sir. We're talking about 1991. We knew
that.

Veterans' Ranking Member ROCKEFELLER. All right, you didn't
know it. Well

Dr. Joseph. We knew it in 1991, Senator.

Veterans' Ranking Member Rockefeller. Sarin was the very
nerve agent that we knew Saddam had because we and our allies
had, in fact, supplied them in an earlier time.

We did know that our soldiers would face horrible conditions in
the Gulf, including a lot of insects. As you described, there was a
lot going on. That doesn't mean that the safety of the troops, the
health of the troops, becomes less important. We did know that
DOD was likely to make extensive use of insecticides and
repellants in the Gulf.

So. Dr. Joseph, knowing just these things, don't you think that
you would have wanted the Department of Defense to have at least
a heightened awareness of possible chemical exposures? To be look-
ing for these reports? To be assuming — leaning over to assume —
that they might be true and therefore there should be heightened
activity just based upon what we did know?

And wouldn't we want our soldiers to assume that bombings and
demolitions of Iraq's weaponry during and after the war, that
maybe, just maybe, would result in some toxic releases? Wouldn't
that have been a pretty good operating assumption?

Dr. Joseph. Well, with regard to the first part of you comment,
Senator, that we, the department thought it was okay because we
didn't know, I mean, I would take very strong exception to that.

With regard to the substance of your comments, I would remind
you that this was in 1991. There was, as I understand it, historic —
this, of course, is a different time, different people, different Ad-
ministration, and there was at that time extreme thought given to
all factors that you have described. I'm sure that was so.

I also know historically that in 1991, as both Mr. McLaughlin
and I have said, that that initial UNSCOM message came in in a
different channel. It came in through the intelligence channel, that
it was not correlated medically. I am not saying whether that was
right or wrong or the best thing. You know, I'm not justifying that
decision. What I'm trying to do is to describe to you today what
happened in 1991 with the first information that came in. It did
not come only to the Department of Defense. That initial UNSCOM
report was widespread in the intelligence and national security ap-
paratus. And it was not placed in it's — I agree with you — proper
and relevant context as to its medical significance. That is what
I'm saying that happened in 1991.

Veterans' Ranking Member ROCKEFELLER. And that it was not
properly placed? I'll — well, let me go ahead.

Dr. Joseph. And it submerged, if I may, it submerged in the ava-
lanche of material or the flood of material that was coming in at
that time.

Veterans' Ranking Member Rockefeller. No excuse.

Dr. Joseph. I don't believe excuse, either.

Veterans' Ranking Member Rockefeller. No excuse whatso-
ever.

Dr. Joseph. I'm not making an excuse, Senator. I'm telling you
what we believed happened in 1991.

Veterans' Ranking Member Rockefeller. And there's been a
long time since 1991. Reference was made by the Chairman earlier
to this letter coming from the Deputy Secretary on the day that
we're having a hearing. It's little bit like the way news of the blow-
up of the deposits of weaponry came about — the Defense Depart-
ment announcement was a hastily called press release about 24
hours after the White House, I believe, had said that they were
going to come out with it. So you can deny that if you want.

Dr. Joseph. I believe it. May I answer?

SSCI Chairman Specter. You may answer. Dr. Joseph.

Dr. Joseph. I believe that both Mr. McLaughlin and I have laid
out to you to the best of our ability, what the sequence of events
of awareness of the various UNSCOM inspections and the U.S.
military and intelligence establishments' knowledge of those an-
nouncements were. We're not doing that, I'm not doing that as an
excuse for what has happened. We're trying to lay out what we be-
lieved happened. And I think the record does show that as soon as
we had awareness of the existence and significance of this event in
Kamisiyah — that's the whole point of the end of my — this is a
war — we then made that public.

Veterans' Ranking Member Rockefeller. Yes, and in the letter
from the Deputy Secretary, he talks about DOD-sponsored research
into possible effects of low-level chemical exposure that will be

funded for a total of $5 million. I'm not even sure of this, but I'll
bet that's the $5 million that Bob Byrd put in for the purpose of
having you all do that.

Now, I'm very interested in the work of your Persian Gulf Ill-
nesses' Investigation Team. That's the investigation team that re-
ports directly to you, am I right?

Dr. Joseph. It reports to me, yes.

Veterans' Ranking Member Rockefeller. I think it was just last
month that this DOD investigation team issued a report on low-
level nerve agent exposure, subject to some discussion this morn-
ing. The DOD report concludes that there is no credible evidence
for chronic illnesses caused by exposures to nerve agents at low
levels in the absence of acute illness or exposure, and that such a
process cannot be reasonably advanced. It says that research in
this area is unlikely, in the extreme, to enhance our understanding
of Gulf War illnesses. Do you agree with that, or do you reject that
report and request further work?

Dr. Joseph. Well, I asked for that report and at the same time,
I asked the Armed Forces Epidemiology Board, a distinguished
group of experts who've been serving the department as a board
since 1941, to undertake a review of the world literature and to
give us a recommendation or a finding on the same topic. They
came to essentially the same conclusion. I'd be happy to provide
you that report as well, sir.

Veterans' Ranking Member ROCKEFELLER. So, is this a possibil-
ity. Dr. Joseph, that you believe we should explore? do you think
there is a reasonable medical possibility that low-level exposure
can cause long-term effects?

Dr. Joseph. I think

Veterans' Ranking Member Rockefeller. Even where

Dr. Joseph. Excuse me, sir.

Veterans' Ranking Member Rockefeller [continuing]. There
has been no acute illness or exposure?

Dr. Joseph. I think both Dr. Kizer and I spoke directly to that
point. The current overwhelming base of medical opinion and
knowledge is that that is not so. Both of us have said and both of
us believe that that knowledge base is not adequate and that we
need to look further into that issue. Yes, sir, to your question.

SSCI Chairman Specter. Senator Rockefeller, if you want to
pursue this line, go ahead.

Veterans' Ranking Member ROCKEFELLER. I have one more ques-
tion, if possible.

SSCI Chairman SPECTER. No, no, go ahead. I just — if you have
a great deal more, I think we ought to yield to some of the other
members, but if you have another question on this line, proceed.

Veterans' Ranking Member ROCKEFELLER. If it's all right, I'd like
to ask one more

SSCI Chairman Specter. Go ahead.

Veterans' Ranking Member Rockefeller [continuing]. On this
one.

I organized a briefing this past May to which DOD did, in fact,
send somebody to, and we heard a presentation by Dr. Abou-Donia
from Duke University, which very much confirmed earlier work
done by a courageous scientists by the name of Dr. Jim Moss. Dr.

Abou-Donia told us about the very likely multiple effects — syner-
gism— of exposure to pyridostigmine bromide, DEET and
permythrin, an effect which I know you do not support. But I un-
derstand that the department has provided sarin to Dr. Abou-
Donia's lab to study its effect in combination with DEET and
pyridostigmine.

Now, Dr. Abou-Donia warned my staff that his findings are not
complete and have not yet been peer reviewed, do you want to tell
us what his preliminary findings are?

Dr. Joseph. I would say first that you and I can argue to great
length the merits of the Abou-Donia or the Moss research, but in
my business. Dr. Kizer's business, we do not regard research as
having validity until it is peer reviewed and published. In both
cases, this has not been the case. I could get into you — I probably
need to refresh my recollection about the various things about the
particular research on chickens that Dr. Abou-Donia has done or
the research on cockroaches that Dr. Moss has done, and to why
we think there is real open question about whether that research
points with any relevance to possible human effects. But the proof
of that pudding will be in peer review and publication.

Veterans' Ranking Member Rockefeller. What he reported to
us just yesterday I thought was interesting. First, he said sarin
causes inaction of certain enzymes in animals, and in most cases,
this is reversible, and recovery from sarin exposure is complete.
That is consistent with your reviews, I would expect?

Dr. Joseph. It is and, of course, it's one of the bases for think-
ing— for the scientific opinion that exists that without acute effects,
you do not have long-term chronic effects.

Veterans' Ranking Member Rockefeller. But what he also told
us that when very low doses of sarin are given in combination with
pyridostigmine and DEET, the enzymes do not recover — this is his
quote — "the enzymes do not recover, and we believe the damage is
irreversible," close quote.

Of what significance would these findings be if they do, in fact,
meet the standards of peer review?

Dr. Joseph. Well, with all due respect, Senator, whatever Dr.
Abou-Donia did or did not tell you in private conversation yester-
day, without seeing any of the data, without having any knowledge
of how it fits into a peer-review structure, I really couldn't com-
ment on that. I don't know what it means. It means — in fact, it
means very little to me. It could, in the long event turn out to have
some significance, but you've shown me no basis for thinking that
that's so in this discussion.

Veterans' Ranking Member Rockefeller. And I've asked that
he send the preliminary report to your attention, and I'll be inter-
ested in your reaction.

Dr. Joseph. May I, if I may just prolong my answer because I
think it's important here. You yourself mentioned that we have
continued to fund his research. I think that is evidence that what
we're far from are trying to close off these avenues of inquiry and
research, we are interested in pursuing them wherever they will
lead. But to know what we have got once we pursue them, that has
to be done in the proper way, and as has been said, it takes time.

Veterans' Ranking Member Rockefeller. So you have a won-
derful advantage, because you and others are able to say, well,
until it's peer reviewed, until it's absolutely in its final form, I real-
ly don't know how I could comment on it. In other words, anything
which comes up, you can push aside because you say, well, there's
no scientific evidence.

Now I happen to have been around this country and in my own
state, and I happen to have seen an awful lot of people — hun-
dreds— who are suffering illnesses that I've never seen before, and
symptoms I've never seen before. You've got the gift and the luck
of being able to say, well, I can't say definitively what this might
be because we have no final proof.

But I just want you to know there's tens of thousands of people
around this country who are suffering, and have been suffering for
five years. The war was in 1991; we had a long time to prepare for
it. And they're probably not quite as sympathetic as some of your
colleagues are to just being able to say until I have the final proof.

Dr. Joseph. Well, if you're suggesting. Senator, that we're
uncaring or insensitive to the veterans, I think the evidence is ex-
actly to the opposite. But your stretch between those two Abou-
Donia discussions and the veterans who are indeed ill and suffer-
ing is a long stretch indeed on the basis of the evidence you have.

Veterans' Ranking Member Rockefeller. And certainly, is a
long stretch in your mind. I understand that very well.

Thank you, Mr. Chairman.

SSCI Chairman Specter. Thank you, Senator Rockefeller.

Senator Shelby.

Senator Shelby. Thank you. Thank you, Mr. Chairman. Dr. Jo-
seph, we've been over some of this before. And I'll try to get to the
crux of it. As you'll recall, I was tasked by Senator Nunn back in
'93 with other people on the Armed Services Committee to look into
this. And we came up with the evidence that we furnished the Pen-
tagon that the Czechs had detected, I believe on more than two
incidences, the presence of chemical agents in the Gulf, that the
French had also detected chemical agents, and at that time I recall
the Pentagon denied all of this. They said it wasn't there; had no
evidence of that. And then it came to light later that the Pentagon,
through the Central Command, had been notified of this. It was in
the bowels of the Pentagon somewhere.

Now, what I'm getting at is something that bothers a lot of us.
And it's deeply troubling to the public. The rediscovery, or resur-
facing of reports of chemical agents and so forth in the Pentagon's
got to be disturbing to the American people, because this has been
going on since, at least since '93, probably back to '91. And yet, we
come before this Committee today and I believe the phrase one of
us used was, the rediscovery, in other words, something is there.

SSCI Chairman Specter. Right.

Senator Shelby. Something that has been denied. Candor is im-
portant. You know, a lot of us, probably most people on this Com-
mittee, this Joint Committee, have really gone to great lengths to
believe the Pentagon, you know, on all this. And then you — we see
doubts there when there's all this denial all the time.

Now, I want to get into something that's deeply disturbing to me.
It's my understanding that it was reported that as many as eight

days of information from March 1991 are missing from chemical
warfare logs. Gap again. Remember the old gap in the tapes and
so forth? If you go back 20 years ago. This is the same time, Dr.
Joseph, that the Army destroyed the Kamisiyah weapons storage
facility in question. Yet, it's our understanding that there's a gap
in the logs. Are any of you on the panel today aware of these logs,
and can you explain why there are gaps in information that could
be so critical to the central question here.

Dr. Joseph.

Dr. Joseph. I have heard recently, I can't remember whether it's
in the last day or two, of that eight day gap. I don't have personal
knowledge of it, but I wouldn't be totally surprised if it were true.
I'm sure if you go looking for any particular piece of information,
related to the logs, et cetera of the war, you might find difficulty
in finding it depending on where it is.

Senator Shelby. Even

Dr. Joseph. I don't

Senator Shelby. Even if this was a critical eight day period in
here and wouldn't it

Dr. Joseph. And that's now the question.

Senator SHELBY. Let me finish.

Dr. Joseph. Yeah.

Senator Shelby. Wouldn't it bother you to say, gosh, what's
missing? This is critical to this — tying all this together. Perhaps
answering a lot of questions. What happened to these missing logs
which obviously contained raw information that could help criti-
cally in this evaluation? Go ahead. Doctor.

Dr. Joseph. And that's exactly why. Senator Shelby, in the part
of my final portion of my testimony which I didn't get to deliver,
and in Secretary White's letter this morning, among the things the
Department is doing and response to the Kamisiyah and all the
watershed changes that it's made, is one, he has tasked the Army
to have the inspector general of the army go back and run the chro-
nology of Kamisiycih. And two, he has tasked the assistant to the
Secretary of Defense for intelligence matters to go back and run
the chronology of Kamisiyah in the Department of Defense. That's
the kind of step that you take when you want candor and you want
to find out what happened back there in 1991.

Senator Shelby. But isn't candor the — should be the order of the
day; not denial? Not saying, gosh, we rediscovered this. We found
something that was in doubt to begin with, you know, that other
people had said was there, and there was denial. Candor's impor-
tant. Isn't, honesty?

Dr. Joseph. Of course it's important. And you know, I've heard
many other officials in the Department of Defense say, previously,
we have no persuasive evidence. We have no — I have said that my-
self on numerous occasions in the past. And I did that on the basis,
and I believe the others did on the basis of their very best knowl-
edge at the time. Now, our knowledge has changed with
Kamisiyah, and we're saying something very different.

Senator Shelby. Mr. Chairman, if you'll indulge I won't take but
a minute.

I've received. Dr. Joseph, some disturbing calls regarding the
Gulf War Syndrome program at the Walter Reed Araiy Medical

Center. I've been told by more than one individual that the staff
there, of this program, are telling patients at Walter Reed — of all
places — that their ailments are psychosomatic. Are you aware of
this treatment of our service members and if you're not would you
look into it?

Dr. Joseph. I will look into that specifically and respond to you
forthwith.

Senator Shelby. Dr. Joseph, could you comment on the recent
study that has found an increased presence of medical problems
with the women that served in the Gulf?

Dr. Joseph. Well, if you're — there was a newspaper article that
I saw yesterday that described that study — that's my only knowl-
edge of it. As you probably know, and as we can provide you in
great detail, we and the VA have a whole range of studies going
on, reproductive health studies, hospitalization studies, morbidity
and mortality. And in our reproductive health study to date and I
believe in yours as well, Ken, we have no evidence for an elevated
rate of reproductive health problems in women. I'm not sure about
the VA, so I shouldn't put words in your mouth. But I know that's
true — at the current stage — it takes time, in our study.

Senator Shelby. We know.

Dr. Joseph, if there were more than a thousand rockets that con-
tained sarin, that were destroyed by the 37th Engineering Battal-
ion— and this is what we've been told — according to eyewitnesses
interviewed by various publications, that the U.S. explosives set off
rockets in all directions for days in the area. Do you dispute that?

Dr. Joseph. I think that's probably a question for Mr.
McLaughlin to respond to. And we're awaiting the modeling which
will give us a sense of what the cone of — or that zone of exposure
would be.

Senator Shelby. But modeling is based on basic assumptions on
anjrthing, is it not?

Dr. Joseph. Yes, sir. Number of rockets, what was in the rocket,
what the meteorology of the day or the time would be. And also,
what you assume is the lowest level that might lead to harm and
maybe some other things.

Chairman Specter. Mr. McLaughlin, if you want to comment,
will you try to do it briefly because we're trying to conclude the
hearing.

Mr. McLaughlin. Yes.

In the case of the second area that we're modeling, the so-called
pit, we're assuming an explosion of about 550 rockets. I could tell
you how we arrived at that figure, if you wish. We're not done with
that modeling, but that's the quantity of weaponry we believe was
exploded there. And we're modeling it with the upper limit assump-
tion in order to get the most extreme outcome we can.

Senator Shelby. Mr. Chairman, thank you for your indulgence.

SSCI Chairman Specter. Thank you. Senator Shelby.

Senator Robb.

Senator RoBB. Thank you, Mr. Chairman.

I certainly shared everyone's frustration about our inability, at
least to date, to define exactly what the problem is and how to re-
solve it. I have a question that I'd like to ask in very general terms,
to get away from some of the more precise matters that I think re-

quire a more detailed analysis. And that's whether or not we have
any evidence of CW agents that we know, on the basis of prior test-
ing, to have the kind of delayed effect that might at least explain
sjonptoms that did not manifest themselves at that time, if the con-
temporaneous interviews are correct, but have clearly manifested
themselves since then in ways that are very troubling at this time.

Number one, are there known agents of this sort in the world in-
ventory?

Number two, are there any such agents that Iraq was known to
possess — or any that we may have had possession of at one time
that we may have somehow, directly or indirectly, provided to the
Iraqis before the Gulf War?

Dr. Joseph. I don't believe so, Senator, but I'd like to just qualify
that remark by saying I want to get back and check the list and
be sure we've got all the medical data before I say so. But I don't
believe so, I don't believe there is anything, you know, our knowl-
edge of what currently exists as chemical or biological weapons,
which would produce this picture that we're describing, particularly
the no acute effects and later chronic effects.

Senator ROBB. Mr Mclaughlin, from the intelligence side, do you
know of anything that would

Mr. McLaughlin. I do not.

Senator Robb [continuing! . Meet that description?

Mr. McLaughlin. No, I do not.

Senator RoBB. All right. Let me just ask one other question and
I'll let the

Dr. KlZER. Could I also respond to that?

Senator Robb. Please, Dr. Kizer.

Dr. Kizer. From VA's perspective, we are privy to what is pub-
lished in the open, peer reviewed literature; what information
might be contained in internal documents or classified we would
not know about.

Senator RoBB. I realize that we could look to other sources, but
gather that, as far as the medical understanding of the effects of
these CW agent's is concerned, we don't know of anything that you
would describe as the most likely agent to induce these kind of
long-term, but not immediate, effects.

Dr. Joseph. That's correct.

I think one other slight caveat, going back to Ken Kizer's earlier
testimony, we don't know what we don't know. And the whole area
of human response to chemical or biological warfare agents is one
in which it is difficult to do research, animal or human certainly,
and in which much of the detail and assurance that we have in
other areas in medicine we don't have. And I think that's why the
issue of now pushing on with that becomes important.

Senator Robb. Well, let me ask you this. As a part of your addi-
tional research and/or modeling, are we cooperating, say, with the
Japanese, who have had the sarin attack in the subway, in terms
of any follow-up with respect to residual symptoms that they might
have, or with some of our own forces that we know were exposed
to mustard gas or other things that we know were at least present
and have been positively identified? Do we have any scientific anal-
ysis of the long-termi effects of those chemical agents on people
whom we know were actually exposed to those agents?

Dr. Joseph. Well, of course, now that we presume that there was
at least some exposure in the Gulf to U.S. troops, that is the whole
importance of having the clinical evaluation program base to look
out in

Senator ROBB. And I understand that. What I'm asking is, are
there other collateral studies or evidence that would at least help
to establish that there are the kinds of residual effects here? Or do
we believe, in effect, that we're dealing with a phenomenon that
has yet to be discovered and analyzed in a way that would enable
us to treat it?

Dr. Joseph. I believe we have a channel for continuing sharing
of information on the topic with the Japanese, but I know of noth-
ing more formal than that, in light of what you're describing.

Dr. KiZER. Let me add that the VA has been collaborating with
the Japanese investigators through one of our environmental haz-
ard centers long before this announcement was made in June. And
I would also note that that is the reason why we're organizing this
international symposium — that is, so that we can capitalize on the
knowledge that may exist in countries other than the U.S.

Senator Robb. Let me ask just one final question of either of our
medical experts, and that is, what is it that we need to know, or
would like to know, in order to solve this particular mystery? Wliat
is it we're looking for that would give us the kinds of either in-
sights or scientific evidence to support some definitive conclusion?

Dr. Joseph. I would say two things, Senator. One is we need to
know, we're looking to know whether in the really massive amount
now of clinical data that we have between the VA and DOD,
whether there are any patterns, whether there are any signposts,
whether there is any clustering that would lead us to some focus
on a particular issue, in particular this one. That I think we have
done an awful lot to put in place.

The second issue is we need to know the answer to the question,
can we be confident that without acute health effects of low level
exposure there are no long-term chronic health effects. And I think,
as we've both said, that's what the current scientific body of opin-
ion is, but we can't be satisfied with that answer. Those two ques-
tions are the most important.

Senator Robb. With sufficient resources, do you believe that
those questions can be answered?

Dr. Joseph. I think the first question we've already put a great
deal of resources into, and I think that question can be answered,
although the great difficulty comes, it's often a question of proving
the negative.

On the second one, I wouldn't hazard an opinion. I know addi-
tional resources and additional work on the topic will get us fur-
ther down the road, but whether it would get us definitively to a
point, I couldn't say, sir.

Senator ROBB. Thank you.

Dr. Joseph. We need to do it.

Senator ROBB. Mr. Chairman, my time is up, and I thank you.

SSCI Chairman Specter. Thank you very much. Senator Robb.

This is obviously not the final hearing on this matter. There are
a great many questions left unanswered. I'm hopeful we'll be able

to conclude the hearing at this point. Senator Rockefeller, do
you-

Veteran's Ranking Member Rockefeller. Sort of a question and
a half.

SSCI Chairman Specter. Okay.

Veterans' Ranking Member Rockefeller. Is that all right?

SSCI Chairman SPECTER. Why don't you take two questions? But
two questions, but only two questions.

Veterans' Ranking Member ROCKEFELLER. No more.

SSCI Chairman Specter. Okay.

Veterans' Ranking Member Rockefeller. Let's get back to the
DOD investigation team report. Dr. Joseph. That report rejects the
primary scientific evidence that supports toxicity of a low-level ex-
posure, which is a 1975 study by Lohs, because it's based on a work
by a Dr. Spiegelberg in 1961 and 1963. Amazing that there's noth-
ing more recent than that.

Dr. Joseph. Well

Veterans' Ranking Member Rockefeller. I'll finish asking my
question, then you answer.

In rejecting the 1975 study, DOD's investigation concludes that
the underlying studies were flawed because the workers who were
studied, quote, "Were making a large number of different agents
and were constantly shuttled back and forth between different
chemical agents, including pesticides." So the underlying studies
were just too uncontrolled in the view of DOD, is that right?

Dr. Joseph. No, I read it quite differently. Senator. The '61 or
'63 work was itself a description of the actual research. The actual
research was done in the late 1930's and 1940's in Nazi Germany
looking for chronic health effects of factory workers who had been
exposed to levels of chemical agents. Now, those factory workers,
were probably not in the best of health, many of them were prob-
ably slave labor in the factories. Two, we know nothing about the
prior state of their health. Three, they were exposed not only to a
variety of agents, but they were exposed, those that survived, over
a long period of time. That's 1930's, 1940's work, and that's what
all the rest of the chain you described is solely based on, sir.

SSCI Chairman Specter. One more question, Senator Rocke-
feller.

Veterans' Ranking Member Rockefeller. And that's all I'll
have.

I'm very aware. Dr. Joseph, that you weren't here in 1991, you
were appointed by the President in 1993, the current President. I
understand that. But I am also aware that the views that you've
expressed in your public statements, in essence, are that you would
not really have done anything different if we had to do this all over
again in the Persian Gulf War — let me finish my question — regard-
ing protection of soldiers' health.

Now, if that is not a fair summary, based upon your current
state of knowledge, what do you think we should have done dif-
ferently to protect our soldiers and investigate their illnesses?

Dr. Joseph. I will tell you, I'll give you a brief resume and I'd
like to also respond to you on paper in greater detail.

What would I not do differently first. I believe — and I know we
may differ on this — that the people who took the decision to immu-

nize our soldiers in the Gulf and to provide them with
pyridostigmine in that setting, took the right decision. That is my
belief and I'd like to believe that if I were in the same position I
would have done exactly that.

What would I have changed?

Veterans' Ranking Member Rockefeller. Even though it was
going to be ineffective against the agent which we knew

Dr. Joseph. Well, that's — excuse me.

Veterans' Ranking Member Rockefeller [continuing]. Was at
play: sarin.

Dr. Joseph. That's, I believe, an oversimplification. Senator. We
did not know that they might not be exposed to soman. I think I
differ with your characterization of PB as counterproductive or
harmful, I guess was the word you used. In the case of sarin expo-
sure, I don't believe that that's quite accurate. And a simple an-
swer to your question, yes, sir. Even though what we knew we
knew, as I understand it, and whether they needed protection I
think that was absolutely the correct decision to take.

Now, what would I have different? Well, one of the things I
would have different is expressed in some detail in my testimony
in terms of the things we have done in the last two years to build
a different way, an improved way to look at before, during and
after deployment, the assessment of health in our troops. That's in
detail in my testimony. I can give you even more detail than that
if you want it. I think it would have clearly been better to have the
kinds of pre- and post-health assessment information, to have the
kind of environmental health monitoring, to have the kind of com-
bat stress teams on the ground, to have the kind of preventive
medical teams on the ground, the way we do in Operation JOINT
ENDEAVOR. That's easy with hindsight to say. But I would have
that differently.

Secondly

SSCI Chairman Specter. If this is going to be protracted. Dr. Jo-
seph, would you supply it in writing please?

Dr. Joseph. Forty-five seconds more and

SSCI Chairman Specter. Go ahead.

Dr. Joseph. Okay. The other thing I would have differently is I
would have a more effective link between the various operational
intelligence and medical views of what might be going on in thea-
ter. I think we've learned that lesson out of the desert. I think we
do do it much better now. Those two things I would have dif-
ferently. The basic decisions. Senator, I think were the correct
ones.

Chairman Specter. I have a few

Veterans' Ranking Member ROCKEFELLER. Thank you, Mr.
Chairman.

SSCI Chairman Specter. Thank you very much. Senator Rocke-
feller— a few words to say in conclusion, but I want to yield at this
time to my colleague. Senator Simpson with one prefatory note.
When I came to the Senate 16 years ago, Senator Simpson was
Chairman of this Committee. He's done a great many things in the
interim before returning to the Chairmanship. But we all know
he's about to depart. This is the last week of the Senate. We expect
to conclude our business yet this week. And he has brought a rare

combination of intellect and balance with extraordinary humor and
levity to guide us in so many of our deliberations. He's received a
lot of accolades, so I'll conclude mine at this point.

Veterans' Ranking Member ROCKEFELLER. I will join you in that
assessment, Mr. Chairman.

Veterans' Chairman SIMPSON. You can both go ahead a little fur-
ther.

[General laughter.]

Veterans' Chairman Simpson. No need for you to fall short.

I thank you. One of these gentlemen will be the Chairman of the
Senate Veterans' Affairs Committee next year, and I wish them
well, because they will continue to be besieged by emotional pres-
sure from groups and people throughout the United States that are
almost overwhelming. They are fueled by a media that will pick up
any possible thing about any person who is sick or ill. The next
chairman will have to do the right thing in the midst of emotion,
guilt, pressure, frustration, all the things I spoke of in the begin-
ning.

The part that has been very frustrating for me all the years of
my Chairmanship and serving with Al Cranston as Ranking Mem-
ber, is to see finally people come and testify and they say, "We
don't really know what the hell went on, but we live in a great
country, and we're dealing with veterans, so just pass the legisla-
tion." Then nobody ever talks about how you pay for it. I know
that's a sick idea. My problem is that I was on the Entitlements
Commission. Members of Congress continue to pour out the Treas-
ury to anybody, regardless of sound medical or scientific evidence.
And at some point, somebody — usually one of those poor veterans
or their children or somebody — is going to have to pay the bill. The
bill today is six trillion bucks. We have two candidates for Presi-
dent and neither one is speaking on that issue in any way whatso-
ever. Medicare, Medicaid, Social Security, Veterans' Benefits, Con-
gressional retirement, and Federal retirement are all depending on
the Federal Treasury, and none of us at this table will be affected
in any way at all. The only people affected will be people between
the ages of 18 and 40 because they will have to pay the bill. When
it comes due, they'll be just wandering around in the swamps. They
won't even know what hit them.

So those are the things that can get you labeled "anti-every-
thing" — anti-veteran, anti-caring, slob of the earth. I've been called
ever3rthing you can imagine in my work as Chairman of the Veter-
ans' Affairs Committee. But I tell you what, I've learned to enjoy
the combat with the veterans organizations — and boy, there are
some tough ones. They do good work and they're sincere.

But the point of any hearing should be — and I commend Senator
Specter and Senator Rockefeller — what happened? When did you
find out? What was done? What are you going to do?

You know, you could have 500 reports on Agent Orange saying
there "ain't nothing there," and then one guy comes up to refute
that and it's the front page of every paper in America. Let me tell
you, ladies and gentlemen, if there were something to do about
Agent Orange, it would have been done by now, but there's no way
to tag it down and tie it down. If there had been, those lawyers

would have done it when they got the settlement out of the chemi-
cal-producing companies for $200 million and walked away.

We need to stick with — and it's going to be hard for these two
gentlemen — the patience and try to ward off those who come in and
know how to work it, and know how to pry the lid off Fort Knox.
I've heard all sorts of witnesses over the years on Agent Orange
and prisoners of war. I remember the guy that said, "I know where
they are. They're in a cage. We've got pictures of them." I said,
"Show them to me and Al Cranston." Then he said, "I'll give it to
you for two million bucks." I said, "Get your butt out of here." We
took care of him.

That's the kind of stuff that goes with this Committee on Veter-
ans' Affairs. We see research on chickens and cockroaches and ev-
erything else. I don't know an3^hing about them but I do know the
difference between chickens and human beings. These are the kind
of things we deal with. They come from the best interests of people
who are deeply concerned but there isn't a single one of us in this
room that isn't a deeply caring person or less caring than somebody
else or you on that panel.

So I have one thing for the record because I see the Internet is
all clogged up on how to send a letter to Congress. I once saw one
that said 60,000 people are on the Persian Gulf Registry. That is
correct, but I want the record to show that 12 percent of the reg-
istry participants report no current health complaints of any kind.
None. Somebody ought to pick that up. We won't ever read it in
the paper or hear it on television. I can assure you. But 7,200 peo-
ple on the 60,000-registry of human beings are saying there's noth-
ing wrong with them at all. Yet I read this sample letter to Mem-
bers of Congress circulating on the Internet. It says,
". . . approximately 60,000 American soldiers who served in the
Gulf War have claimed they may be ill due to various chemical and
biological exposures. . . " unquote. That is not true. I deal with a
lot of stuff as Chairman of this Committee that isn't true.

So I am going on to Harvard. My God, that will be a marvelous
experience.

I can just say that if anyone can show me that there are hun-
dreds or thousands of human beings in this country, especially vet-
erans, who are not being cared for, then I'm going to refer them
to this man right here. Dr. Kizer. To me he holds the promise of
doing the most extraordinary job that I have ever seen pursued in
his work. I commend him. He is the most able VA spokesman dur-
ing my tenure because he doesn't mess around. He lays it out. The
veterans service organizations go goofy sometimes, and the sci-
entists go goofy sometimes, and I go goofy sometimes, but he
doesn't. I commend him. So if anyone writes to the panel or if we
hear from somebody again about what are we doing for the veter-
ans of the United States, tell them, "Everything a caring nation
can do." We're continuing to do it. What we're doing for the Gulf
War veterans is extraordinary, and what we did for the Vietnam
veterans would fill books compared to what we did for the World
War I veterans. We just let them die out. And the World War II
veterans — we've taken care of them as best we can.

So that's my swan song, and I want to thank you. It's been a
good run, and I admire you all greatly. I admire Senator Rocke-

feller. He feels passionate about these things. I don't share his pas-
sion at all. Senator Specter will be just as passionate. You'll hear
about his father Harry. I've heard that. He must have been a won-
derful guy. I tell him about my father Milward who was a member
of the Army in the First World War. I commend them and wish
them well. God Speed.

Thank you very much.

SSCI Chairman Specter. Thank you very much, Senator Simp-
son. It's not possible to top Senator Simpson, so I shall not say
much.

We'll be visiting this subject in the future, beyond any question,
and my hope would be that we move ahead to get conclusions very,
very promptly. I would have preferred. Dr. Joseph, to have heard
some responses as to the question put by some of the doctors even
without peer review. It is a very different standard when you go
into a court and you offer expert witnesses, and you have juries
make conclusions, contrasted with the sovereign immunity which
the Government of the United States has — for good reason — but we
have to move ahead.

And when you were asked the question — after saying we found
out about it in June of this year — could we have found out about
it sooner, you said, well, that's hard to say. I believe that the gov-
ernment owes a very, very high duty to move ahead with speed,
and to make the inquiries, and to find out before the government
is pressed. But we will revisit this in some substantial detail, and
we'll miss Senator Simpson.

I would ask unanimous consent, that without objection, the letter
from Deputy Secretary White dated today, to Senator Thurmond
will be made a part of the record in conclusion, and the New York
Times article of September 6, 1996.

[The letter and the article referred to follow:]

Deputy Secretary of Defense,
Washington, DC, September 25, 1996.
Hon. Strom Thurmond,

Chairman, Senate Armed Services Committee,
U.S. Senate, Washington, DC.

Dear Mr. Chairman: The Department of Defense continues to investigate vigor-
ously matters relevant to the illnesses of Persian Gulf War veterans. I want to re-
port to you on the status of our current efforts, and to apprise you of the fact that
we are redoubling our efforts, broadening the scope of our investigations and adding
additional resources to the effort in light of several recent developments.

At the end of the Gulf War, American troops moved rapidly through Iraq destroy-
ing ammunition storage facilities. At one of these facilities, Khamisiyah, we have
learned that U.S. troops destroyed chemical munitions on two separate occasions.
The troops were unaware of this at the time. At this time, we do not know if U.S.
troops were exposed to toxic chemicals during these events, but this new informa-
tion requires more research and a vigorous investigation. We must now broaden our
efforts and intensify our focus on the possibility of low-level exposures of U.S.
troops.

We are making every effort to contact individuals who were present at the site
and to enroll them in our clinical evaluation programs. We remain committed to the
care and welfare of our active duty personnel and of our veterans.

In light of these developments, I am today initiating a number of immediate and
longer-term actions with regard to the Department's efforts concerning sponsored
medical research, clinical evaluations, document review and declassification, and in-
vestigations of specific incidents. These efforts include:

Forming an Action Team to completely reassess all aspects of our program. This
team will report directly to me.

Drawing on additional outside analj^ical and management resources to help in
the reassessment because the new information demands new and different exper-
tise.

In addition to the reassessment, I am directing the following specific initiatives
immediately:

1. DoD-sponsored research into the possible effects of low-level chemical exposure
will total $5 million. In addition, I am directing the Assistant Secretary of Defense
for Health Affairs to explore further research projects in this area where additional
resources could be usefully applied.

2. Our clinical investigation efforts will be broadened, in an effort to include per-
sonnel in the area of potential exposure around Khamisiyah in our comprehensive
clinical evaluation program.

3. The Department of Defense will ask the Institute of Medicine to re-validate
DoD clinical protocols and practices in light of possible low-level exposure.

4. The Secretary of the Army has been directed to instruct the Army Inspector
General to conduct an inquiry into the events surrounding the destruction of the
munitions at Khamisiyah and supplement the efforts of the DoD Persian Gulf Inves-
tigation Team where possible.

5. The Assistant to the Secretary of Defense for Intelligence Oversight will inves-
tigate and report to me on the information received by the government pertaining
to Khamisiyah in 1991 and any other related intelligence information and to report
on the procedures by which this information was handled.

6. The Interagency Security Classification Appeals Panel (ISCAP) has been asked
to undertake an objective review of the process and guidelines by which documents
are declassified and placed on GULFLINK and to provide recommendations regard-
ing this process.

This Administration, and Secretary Perry and I personally, remain committed to
a full effort to understand Persian Gulf War Veterans illnesses and to provide all
necessary medical care. We will keep you apprised of our efforts in this area. Thank
you for your support.

[From The New York Times, Sept. 6, 1996, Friday, Late Edition— Final]

Presidential Panel Says Pentagon Lacks Credibility for Inquiry on Nerve

Gas Exposure

(By Philip Shenon)

Investigators for a Presidential advisory committee said today that the credibility
of the Defense Department had been "gravely undermined" by its inquiry into the
possible exposure of American troops to Iraqi chemical weapons during the 1991
gulf war. They recommended that the investigation be taken away from the Penta-
gon and handed over to an outside body.

The investigators also concluded that as many as 1,000 American troops — more
than double the number that had been originally reported by the Pentagon — were
exposed to sarin, a deadly nerve gas, when a battalion of American combat engi-
neers blew up an Iraqi ammunition depot in March 1991.

"The Department of Defense has conducted a superficial investigation of possible
chemical and biological agent exposures which is unlikely to provide credible an-
swers to veterans' questions," the investigators said in a statement presented today
to the Presidential Advisory Committee on Gulf War Veterans' Illnesses, a panel
created last year by President Clinton. "A credible review of these allegations and
concerns cannot be accomplished by the Department of Defense."

The findings by the investigators, who work for the 12-member committee ap-
pointed by the Wliite House, were an indictment of the leadership of the Pentagon,
which until this year had insisted publicly that it had no evidence that large num-
bers of American soldiers had been exposed to chemical or biological weapons de-
spite reports of mysterious, debilitating illnesses among thousands of gulf war veter-
ans.

The Defense Department defended its investigation of the issue, with its senior
health officer, Stephen C. Joseph, telling the panel at a public hearing today that
the Pentagon's internal inquiry into gulf war illnesses had been "a major contribu-
tion to the department and, we would suggest, to the public."

The investigators' findings have not been formally adopted by the panel — that is
expected to happen late this year, as the panel completes its final report — but there
was no substantive criticism of the findings when they were discussed in today's
hearing.

The panel is led by Joyce C. Lashof, a physician who is the former president of
the American Public Health Association, and includes several other prominent sci-
entists and researchers.

'The Department of Defense's official position has remained essentially un-
changed, and that can be summarized as the three no's — there was no use, there
was no exposure, there was no presence," the committee's chief investigator, James
Turner, told the panel at the hearing.

'The inflexible reassertion of this position in the face of growing evidence that
there were possible low-level exposures — there were chemical munitions in the Ku-
waiti theater of operation, there were releases — have served to gravely undermine
the credibility of the Department of Defense's internal investigation."

He said that the Pentagon team in charge of the investigation had spent too much
time on scientific research that would be "more appropriately delegated to other
components of the Department of Defense" and too little time in studying intel-
ligence reports and combat logs, and in interviewing veterans who said they had
evidence that chemical and biological agents were released.

A member of the panel, Andrea Kidd Taylor, an occupational health consultant,
said the Pentagon's handling of the issue had created "the feeling of cover-up, even
if there isn't any cover-up."

In testimony before the committee. Dr. Joseph, the Assistant Secretary of Defense
for Health Aff'airs, rejected the criticism of the Pentagon's investigation, and sug-
gested that the internal inquiry would continue despite the recommendation today
that it be handed over to an outside body.

"While we are always open to constructive criticism, let me respectfully suggest
that this concern fails to recognize and appreciate the department's complete com-
mitment to investigating the possible causes of Persian Gulf illnesses in the context
of its support for all gulf war veterans," he said.

Still, Dr. Joseph said that the Pentagon was willing to consider new methods of
investigating the issue "if together we can work out an alternative rule of thumb
for which things we should look at."

The Defense Department's credibility on the issue has been shaken in recent
weeks, especially after the disclosure in June that a group of American conbat engi-
neers may have been exposed to nerve gas and mustard gas when they blew up the
Kamisiyah ammunition depot in southern Iraq in March 1991.

Pentagon officials initially said they had no conclusive evidence that any Amer-
ican soldiers had been exposed to chemical weapons at the depot but that 300 to
400 troops had been in the vicinity at the time of the explosion.

But based on evidence compiled by the Central Intelligence Agency, investigators
working for the Presidential advisory committee said today that the number of
troops who might have been exposed to nerve gas was actually about 1,100. And
they reported that the evidence of the release of chemical agents at Kamisiyah was
"overwhelming" and that "exposure to troops within 25 kilometers of the demolition
activity should be presumed."

Despite the Pentagon's repeated assertion that it had no evidence that American
soldiers had been exposed to Iraqi chemical weapons, a long-classified intelligence
report made public last week showed that senior officials at the White House, the
Pentagon, the Central Intelligence Agency and the State Department were informed
in November 1991, eight months after the demolition, that chemical weapons had
been stored at Kamisiyah.

Dr. Joseph said today that it was not surprising that the reports were overlooked
in 1991 since at that time, "no one was thinJdng about a large number of our armed
forces coming back and complaining of symptoms and illnesses following their serv-
ice in the gulf war."

Mr. Turner, the panel's chief investigator, was also critical of the Pentagon's
"slow, reluctant, on-again, off-again release of information to the public." He said
that it had "served to also undermine credible confidence in the Department of De-
fense's efforts."

James J. Tuite 3d, a former Congressional investigator who is the founder of the
Gulf War Research Foundation and has emerged as a chief critic of the Pentagon
on the issue, welcomed today's findings. He described the Defense Department's in-
vestigation of gulf war illnesses as "dishonest and irresponsible" and said that it
had been influenced by a "vested interest in the outcome of the investigation."

SSCI Chairman SPECTER. We thank you, Mr. McLaughHn. I note
that you've been accompanied here today by Ms. Sylvia Copeland,
who is chief, Gulf War Illness Task Force. We thank you, Dr. Jo-
seph, for your service. Most of the questions were directed at you

because essentially, it is the Department of Defense response that
we need. We thank Dr. Kizer, and note that he's been accompanied
by Dr. Francis Murphy, Director of the Environmental Agents
Service, Department of Veteran Affairs.

That concludes our hearing. Thank you all very much.

[Thereupon, at 1:12 o'clock p.m., the hearing was concluded.]

CIA Report on Intelligence Related to
Gulf War Illnesses

2 Ausust 1 996

CL\ Report on Intelligence Related to
Gulf War Illnesses

Key Findings:

On the basis of a comprehensive renew of intelligence and other information, we assess
that Iraq did not use chemical or biological weapons or deploy these weapons in Kuwait
In addition, analysis and computer modeling mdicate chemic^ agents released by aerial
bombing of chemical warfare facilities did not reach US troops in Saudi Arabia. Coalition
bombmg resulted m damage to filled chemical munitions at only two facilities-
Muhammadiyat and Al Muthanna-both located m remote areas west of Baghdad.
UNSCOM inspections concluded that no chemical munitions were destroyed at the An
Nasinyah Ammumtion Storage Area, countering publicized theories that fallout from the
facility were the cause of credible but unverified nerve agent detections in Saudi Arabia.
We assess no biological weapons or agents were destroyed by Coalition forces dunng the
Gulf war. Finally, Iraq never produced radiological weapons for use and bombed Iraqi
nuclear facilities caused only local contamination north of the Kuwait Theater of
Operations.

A recent assessment based on a comprehensive review of all intelligence information and a
May 1996 UNSCOM inspection concludes nerve agent was released as a result of
inadvertent US postwar demolition of chemical rockets at a bunker and probably at a pit
area at the Khamisiyah Ammunition Storage Area in Iraq. We have modeled the chemical
contamination levels in Iraq resulting from the bunker destruction so that the DOD can
assess who may have been exposed. Analysis of demoUtion activities in the pit area is still
under way.

40-180 97 - 3

Contents

Page

Key Findings iii

No Intentional Iraqi Use of Chemical or Biological Agents I

Chenucal Weapons at Two Southern Iraq Depots: An Nasiriyah and Khamisiyah 1

An Nasinyah; Chemical Muniuons Moved to Khamisiyah 1

Khamisiyah; Some Chemical Mumtions Destroyed by Groimd Troops 2

Bunker 73 Rocket Destrucuon 3

Pit Area Rocket Destruction 3

Open- Area Mustard Shells Intact 3

Modeling ot Release of Agents From Bunker 73 4

Chemical Fallout From Aenal Bombing: At Muhammadiyal and Al Muthanna 5

Muhammadiyat 5

Al Muthanna 7

No Evidence of Biological Fallout From Aerial Bombing 7

Iraqi Chemical and Biological Agents 7

Other Potential Hazards 8

Red Funning Nitric Acid (RFNA) 8

Radiological Weapons and Radiation Fallout 8

Miscellaneous 8

Future Efforts 8

Text Box

Modeling Assumptions About Bunker 73 4

Table

Selected Suspea Chemical Weapons Sites Examined 6

CL\ Report on Intelligence Related to
Gulf War Illnesses

No Intentional Iraqi Use of Chemical or Biological Agents

We assess that Iraq did not use chemical or biological weapons against Coaliuon troops based on our
thorough review ot intelligence reporting and on the lack of casualaes that was a signature ot chemical
use dunng the Iran-Iraq war. We assess that Iraq probably did not use these weapons because of a
perceived threat of overwhelming Coalmen retaliation.

Chemical Weapons at Two Southern Iraq Depots: An Nasiriyah and Khamisiyah

We assess that Iraq had chemical weapons at two sites (see figure 1) m Iraq-ihe An Nasinyah
Ammuniuon Storage Depot SW and the Khamisiyah (US name Tall al Lahm) Ammunition Storage Area-
within the Kuwait Theater of Operauons (KTO)' during Desert Storm. Both of these sites were large
rear-area depots near the northern boundary of the KTO that stored mostly convenuonal ammuniaon.
UNSCOM reporting and other informauon mdicate that Coaliuon bombing did not destroy the bunker
containing the chemical agents temporanly stored at An Nasinyah. We have recently determmed US
troops were near a release of chemical agents at Khamisiyah, and DOD is assessing potential exposure.

An Nasiriyah: Chemical Munitions Moved to Khamisiyah

According to Iraqi statements to LT^ISCOM in May 1996, An Nasiriyah stored 6,000 155-mm mustard
rounds from early January until they were moved to Khamisiyah after 15 February 1991. Iraq stored the
muniuons starting just before the air war at one bunker-called Bunker 8 by Iraq-at An Nasinyah
Ammunition Storage Area SW. According to Iraq, these mustard rounds were moved to Khamisiyah
because of fear of addiuonal Coalition bombmg.

The Coahuon bombing of An Nasinyah on 17 January 1991 did not cause a release of chemical agent
because the bunkers that were bombed on that date did not contam chemical agents. In May 1996.
UNSCOM inspectors examined the rubble surrounding the bunkers at An Nasinyah that were bombed on

' Generally defined as Kuwait and Iraq below 31 degrees north latitude."

17 Januarv' 1991 and Jetennuied thai the bunkers contained only convenaonal weapons AlLbous^h
mustard rounds uere in Bunker 8 at An Nasinyah on 17 Januar\-, UNSCOM infonnauon indicates they
were not damaged. No other agents were known to he at An Nasinvah.

Khamisiyah: Some Chemical Muxutions Destroyed by Ground Troops

L'NSCOM mspected chemical muniuons at or near Khamisiyah in October 1991 and idenufied i;2-mm
sann/cyclo-sann (GB/GF) nerve-agent-filled rockets and 155-iiun mustard rounds. At that tume it was not
clear whether these chemical weapons had been present dunng the Gulf war or whether, as was suspected
at other iocauons, the Iraqis moved the muniuons there shortly before the 1991 UNSCOM inspecuon.

Dunng Its October 1991 inspecuon of the Khamisiyah facility, the Iraqis told UNSCOM thai Coahuon
troops had desaoyed chemical weapons at a bunker earlier that year, and L^SCOM found chemical
muniuons at two open sues (see figure 2);

• Remnants of 122-irun rockets were idenufied at a single bunker among 100 bunkers, called "Bunker
73" by Iraq. It was unclear whether the muniuons in Bunker 73 were chemical because there was no
samplmg or posiuve chemical agent monitors (CAM) readings and inspectors did not document
characiensuc features of chemical muniuons.

• Several hundred mostly intact 122-mm rockets containmg nerve agent-detected by sampling and with
C.\Ms-were found at a pa area about 1 km south of the mam storage area.

• Over 6.000 intact 155-mm rounds containing mustard agent, as indicated by CAMs, were found in an
open area several kilometers west of Khamisiyah.

" This sutement. however, was viewed with skepticism at the tune because of the broad, continuous use of deception
by the Iraqis against UNSCOM.

Fi«^ure 1. Iraq's Declared Wartime CAN Agent Stockpile

AIMawsil 1 IX i-i v*c

•

Al Muthanna

Saddam Airbase
Al Tuz Airfield
\ Al Bakr Airbase

Al Qadisiyah
Airbase

• ▼Dujayl

\^*Baghdad

Muhammadiyat

\^^" — Tammuz Airbase

• #

^ — Fallujah Proving
Ground

An Nasiriyah'

— \, _ - 3r N

Khamisiyah / •
m^ ^ Al Basrah

Munition Types:

A = Artillery Shells
0 = Bombs
Y - Missile Warheads
■ = Artillery Rockets
^ = None (Bulk Storage)

CW Agents:

= Mustard (Undamaged)

■ = Mustard (Damaged)

■ = Sann/GF (Undamaged)

■ = Sarin/GF (Damaged)

'Moved to Khamisiyah after 15 February 1991

GWC'/V 01-796

Kiyure 2. Khamisivah Ammunition Storage Area

39 4tt: 41

Bunker 73 Rocket Destruction. The recent comprehensive review of all informauon enabled us to

determine that L'S troops-not Iraq-destroyed the rockets in Bunker 73. In March 1996. in conjuncuon
with DOD uivesucaiors. we determined that the US 37th Engineenng Battalion had destroyed that bunker
along with over 30 other bunkers on 4 March 1991.

However, it was not until L'NSCOM's May 1996 inspecuon at Khamisiyah that it was deieniuned that
Bunker 73 contained remnants of 122-mm chemical rockets. Dunng this inspecuon, inspectors
documented the presence of high-density polyethylene mserts, burster tubes, fill plugs, and other features
charactensuc of Iraqi chemical muniuons. Analysis of the contents of the rockets that UNSCOM found in
1991 in the pit area just outside the Khamisiyah Storage Area shows that the idenucal rockets in Bunker
73 had been filled with a combinauon of the agents sann and GF. Therefore, we conclude that US troops
destroyed chemical rockets m Bunker 73.

Pit Area Rocket Destruction. Dunng the May 1996 UNSCOM inspection, Iraq claimed that some of the
rockets located m the pit area had been destroyed by occupying forces. On the basis of very recent
mterviews of 37th Engineenng Battalion personnel, DOD now believes that demolition personnel did set
charges on stacks of rockets m the pa on 10 March 1991 at 1630 local time.

We are sull trying to deiermme the number of rockets US forces could have destroyed. Once we
determine the number, we will model the likely hazardous area caused by the destruction. Iraq told the
May 1996 UNSCOM inspectors that it moved about 1,100 rockets out of Bunker 73 to the pit 2 km away
to avoid chemical contamination of the bunker facility. The Iraqis claimed the rockets started leaking
unmediately after they were transferred from the Al Muthanna CW Production and Storage Facility just
before the air war.

Open-Area Mustard Shells Intact As discussed previously, more than 6,000 mustard rounds were
moved from An Nasinyah to an open area several kilometers west of the main facility at Khamisiyah.
These munitions were found undamaged by UNSCOM in October 1991. They were later moved to and
destroyed at UNSCOM's Al Muthanna destrucuon facility.

Modeling of Release of Agents From Bunker 73

Modelin^j ot [he potenLuJ hazard caused by destruction of Bunker "? indicates that an area around the
bunker at leait 2 km in all direcuons and 4 km downwind could have been contaminaied at or above the
level tor causing acute sv-mptoms including runny nose, headache, and miosis (see figure 3 and text box).
.\n area up to 25 km downw uid and 8 km wide could have been contaminated at or above the much lower
general populaaon dosage limit. From wind models and observaaons of a video of destrucuon activitv at
Khamisiyah. we deiermmed that the downwind direction was northeast to east (see figure 4).

Modeling .Assumptions .\bout Bunker 73

Some ot ihe following modeling assompaons were based on data from US testing m 1966 that mvolved descrucnon of
a bunker filled with 1 .850 GB rockets with maximum range similar to that of Iraqi rockets found in Bunker 73:

• 1.060 rockets is indicated by Iraq.

• Rockets tilled uith 8 kg of a 2. 1 ratio of GB to GF (contents assumed to be 100 percent agent) based on
UNSCOM mformatjon and sampling from the pit.

• Ten percent of rockets ejected from the bunker, half of which randomly fall within a 200-meter circle, the other
half fallmg withm a 2km cu-cle based on US tesnng '

• Ejected rockets released agents on impact.

• A 15 -meter mean agent release height was chosen to be conservauve when determining ground hazard.

• .AJl but 2.5 percent of agent in the bunker degraded by heat from explosion and motor/crate burning based on US
tests.

• Wmds slow to the northeast to east, based on modelmg and analysis of a videotape of the destrucaon acUvity at
Khamisiyah.

• Our models do not include the effect of the reported 32 to 37 convenuonal ordnance bunkers detonating and
burning simultaneously with the chemical bunker. The added thermal energy created by explosions and fires m
the other bunkers and solar heating caused by the mcreased amounts of smoke would tend to degrade agent as
well as more qiuckly disperse the agent between the ground up to the maximum altitude of 800 to 1.200 meters *'
This more rapid vertical spreading would tend to lower ground contamination in the area.

DOD dociunents and mulople veterans reported thai munition "cook-offs"-nxuniQoiis that ignite and are ejected froin their storage due to
Ihe demoliuoQ fire-sent ordnance as far as 10 km or more from ihe bunker faality. Nonetheless, we did not model this phenomena
because we have been unable lo detennine whether any of the cook-ofis involved chemical rockets, and tf so. the aumber of rockets and
how far they went

This alutude represents the estimated height of the mixing layer-the lower luibuJent part of the aunosphere above whidi agent transport
IS inhibited due to a laminar boundary layer. This layer can often be seen from aircraft while landing in aues with polluted air.

The Army estabUshed this dosage cntena for protection of the general population: a 72-hour exposure at
0 000003 mg/m3-signLficanlly lower than the 0 0001mg/m3 occupational limit defined for 8 hours-is specified.

Fisiure 3. 6.4-\letric-T()n Rele;ise of Sarin at khamisivah Storage Area.
Bunker 73 on 4 March 1991 ( 1 1(X)Z)

vt"^-^'^^^ /^

^1*^"^ ■■

[.'■ -■

';,3j><

_4('' — /

L ^

%=^

,475 :

-v^^

\VJIJ

.^K^^Ki '^.Mr'rif W ^

C^«.

"""^8

t— — __.

H^BHH

fe^

U:p.*w

cr j

0 ^^=.,20^
Kilometa^^^

..]

' v-^/

^ ^''rf^-

^jg

Lethal

Incapacitated/Disabled

Vision Impaired
(Miosis)

First Effects '*

(Runny nose, watery eyes)

8-Hour Occupational Umit
(0.048 mg-min/m3)

72-Hour General Population Limit
(0 013 mg-min/m3)

First effects also may include tightness of chest,
coughing, skin twitching, sweating, and headache

2.5% Effective Release,
fVlean Cloud Height 15 Meters

I R AQ

Khamisjyah<

j-iuure 4. Determining NN ind Direction Durintj Demolition of Bunker 1} at Khamisi\ah

Video Camera
Vantage Point

U'<:

At 1405 on 7 March 91
at Khamisiyah
Sun Azimuth = 196'
Sun Elevation = 52"

Apparent Wind Direction
Based on Smoke Drift

• Shadows fall and snnoke drifts roughly to the viewer's left
in the video. On the basis of sun angles, this puts the wind
direction in the northeast quadrant and puts the viewer
roughly to the northwest.

Chemical FaJIout From Aerial Bombing: At Muhammadiyat and Al Muthanna

We conclude Lhat Coalition aenal bombing damaged filled chemical muniaons at two facibtjes-
Muhammadiyat and .AJ Muthanna. In reaching this assessment, we examined all intelligence
reporung on the locauon of chemical weapons in Iraq and the KTO and scruunized dozens of sites
I see table) lhat uere alleged to be connected m one way or another with chemical weapons. Our
modeling indicates that chemical agent fallout from these faciUties-both located in remote areas west
of Baghdad-did not reach troops m Saudi Arabia. Finally, we have found no information to suggest
that casualties occurred mside Iraq as a result of chemical warfare (CW) agents released from the
bombing of these sites-probably because these two facilmes are m remote locauons far from any
populauon centers. The Muhammadiyat and Al Muthanna sites are both over 30 km from the
nearest Iraqi towns.

According to the most recent Iraqi declarauons, less than 5 percent of Iraq's approximately 700
metric tons of declared chemical agent stockpile was destroyed by Coaliuon bombing. In most cases,
the Iraqis did not store CW munitions m bunkers that they believed the CoaUuon would target The
Iraqis stored many CW munitions m the open, protecung them from Coaliuon detecuon and
bombing because we did not target open areas. In addiaon, all known CW and precursor producuon
Imes were either inactive or had been dismantled by the start of the air campaign.

Muhammadiyat

Iraq declared that 200 mustard-filled and 12 sarin-fiUed aenal bombs at the Muhammadiyat (US
geographic name Qubaysah) Storage Area were damaged or destroyed by Coaliuon bombmg. We
have modeled the contaminated area resulting from bombing of Muhammadiyat, a site at least 410
km from US troops stationed at Rafha and even further from the bulk of US troops (see figure 5).
Bombing of this facility began on 19 January and contmued throughout the air war. We have been
unable to determine exactly when the chemical bombs were destroyed. On the basis of recent Iraqi
declarauons, we have modeled a release of 2.9 metnc tons of sarin and 15 metric tons of mustard on
all possible bombing dates to find the largest most southerly hazardous area. Southerly winds
occurred for only a few of the days the site was bombed. Figures 6 and 7 show that for general
population limit dosages (above 0.013 mg-min/m3), downwind dispersions in the general southerly
direcuon for sarin and mustard fall below this level at about 300 and 130 km. respecuvely.

Selected Suspect Chenucal Weapons Sites Examined'

Facilities

.AJ Muthanna (Samarra)

KiamiMvah iTaJl aJ Lahmi

Muhammadiyai (Qubaysah Storage Depot)

AJ Wahd .Airbase i H3 .Airfield)

FaJluiah I iHabbaniyah III)

Fallujah III iHabbaniyah I)

M Bakr Airfield [subordinate] (Samana East .Airfield)

.Al Taba'ai .Airstnp (H3 SW .Aorfield)

.Al Tuz Airfield (Tuz Khunnatu Airfield)

Dujayl/Awarah (Sumaykab SSM Suppon Facdiry SE)

Falluiah Chem Proving Gnd (Habbaniyah CW Training Center)

Murasana Airbase (H3 NTW' Airfield)

Qadisiyah .Airbase <.A1 ,Asad .Airfield)

Saddam .Airbase iQayyarah West Airfield)

Tanunuz .\irbase i.AI Taqaddum Airfield)

Al Qaim Superphosphate Fertilizer Plant

Al Taqaddum .Airfield

An Nasinyah Ammo Storage Depot SW

Ash Shuaybah .Ammo Storage Depot

Baghdad Ammo Depot Taji

Fallujah II (Habbaniyah 11)

K-2 Airfield

Kirkuk .Airfield

Kirkuk Ammo Depot West

Mosul Airfield

Qayyarah West Airfield

Qayyarah West Ammo Storage Depot

Tallil Airfield

Ubaydah Bin al Jarrah Airfield

Ad Diwaniyah .Ammo Depot

Al Fallujah Ammo Depot South

Ukhaider (Karbala Depot and Ammo Storage)

Qabauyah Ammo Storage fWadi al Jassiyah Ammo Storage)

Tiknt Ammo Depot (Salahadin)

Coordinates

3351N/04349E

3045N/04623E

3315N704:41E

3;56N/03945E

3329N704349E

3333N/04338E

341 ON/044 16E

3245N/03936E

3457N704428E

3349N/04415E

3308N/04352E

3305N/03936E

3347N/04226E

3546N/04307E

3320N704336E

3422N/O41I0E

3320N/O4336E

3058N/04611E

3029N/O4739E

3333N/04414E

3329N/04340E

3455N/04605E

3528N/04421E

3533N/04358E

36I8N/04309E

3546N/04307E

3552N/04307E

3056N/04605E

3229N704546E

3158N/04454E

3313N/04341E

3223N/04330E

3352N/04242E

3443N/04339E

These sites represent examples of sites that have been connected-often tenuously-to Iraq s chemical warfare
program.

Figure 5.

Iraqi Facilities With Damaged Chemical-Agent

-Filled Munitions

■

IRAQ

Al Mawsil

i
i

•

Al Muthanna

.. .- .. 4^80 km
MuhammadiyatA / ^^

T / Baghdad

[

410 km\ /470 km

\ / KhamisiyahA

•
Al Basrah

Rafha*

KUWAIT

•
Kuwait City

KKMC*

GWCW03-7 96

40-180 97-4

Figure 6. Worst C ase Ma/ard Footprint for 2.9-Metric-Ton Sarin Release
at Mijhammadi>at Storage \rea

IRAQ

Al Mawsil

• 1

!
Al Muthanna

▲

Muhammadiyat A

\ ""^

10% Effective Release: KhamisiyahA

Mean Cloud Height 15 Meters •

A[Basrah

Rafha» ^^j^^,^

•

First Effects '* Kuwait City
(Runny nose, watery eyes)

! 8-Hour Occupational Limit KKMC»
I (0.048 mg-min/m3)

72-Hour General Population Limit
1 (0.013 mg-min/m3)

" First effects also may include tightness of chest,
coughing, skin twitching, sweating, and headache

Scale 1 inch = 160 km %

Gwcw :5-:96

Figure 7. Worst C ase Hazard Footprint for 15.2-Metric-Ton Mustard
Release at Muhammadi\at Storage Area

1 R AQ

Al Mawsil

•

aAI Muthanna
i Muhammadiyat .

X Baghdad

1
i

! 10% Effective Release: KhamisiyahA
Mean Cloud Height 15 Meters •

Aj Basrah

Rafha» ^^j^^,^

•

First Effects " Kuwait City
(Runny nose, watery eyes)

i 8-Hour Occupational Limit KKMC«
i (0.048 mg-min/m3)

72-Hour General Population Limit
(0.013 mg-min/m3)

" First effects also may include tightness of chest,
coughing, skin t^A/ltchlng, sweating, and headache

i Scale 1 inch = 160 km

GWCW 07.7 96

Neither the first effects nor the general populauon limit levels would have reached US troops thai
were siauoned in Saudi .Arabia.''

Al Muthanna

Iraq Jeclared that 2.500 chemical rockets containing about 17 metnc ions of sarin nerve agent at .\1
.\luihanna (US geographic name Samarra). the primary Iraqi CW producuon and storage facibty, had
been destroyed by Coahuon bombing. LT^SCOM inspectors were unable to verify the exact number
because of damage to the rockets. We have modeled possible bombing dates for this bunker and
determined that the most southerly dispersal for reaching the general populauon limit dosage is 160 km
( figures 8). well short of US troops.

No Evidence of BiologicaJ Fallout From AeriaJ Bombing

There are no indicauons that any biological agent was destroyed by CoaliUon bombing. Available
intelligence reporung and Iraqi sutements indicate that Iraq went to great lengths to protect its
biological muniuons from aenal bombardment. The Iraqis have stated that its biological-agent-filled
aenal bombs were deployed to three airfields welJ north of the KTO. The bombs were placed m open
pits far from bombing targets, then covered with canvas, and buned with dirt. Iraqi biological
warheads for Al Husayn missiles were hidden well north of the KTO both m a railroad tunnel and in
earth-covered pits al a locauon near the Tigris canal. The Iraqis admitted to production of biological
agents at four sites near Baghdad but said it ceased producuon before the air war. In addition,
UNSCOM found no damage to any of these faciliues from Coalmen bombmg.

Iraqi Chemical and Biological Agents

We found no evidence that would indicate that Iraq developed agents specifically intended to cause the
most common types of long-term symptoms seen in lU Gulf war veterans. This finding is unporiani in
rulmg out the scenano of covert use of such an agent With the possible exception of aflaioxm, all
declared Iraqi agents were intended to cause rapid death or incapacitation. The only documented effects
of aflaioxm in humans are liver cancer months to years after it is ingested and symploms-possibly
mcluding death-caused by liver damage from ingestion of large amounts. Effects of aerosolized aflaioxm
are unknown. UNSCOM assesses that Iraq looked at aflaioxm for its long-term carcmogemc effects and

When predicting very low concentration levels far downrange of the source, large dispersions are created that are
difficult to model. We assess, however, that our results are biased upward because we chose optimal times and dates
that would have produced the maximum dispersion toward Saudi Arabia In addidon. the models do not account for
phenomena-such as deposition onto the ground and rain removal of agent-that would grcady diminish potential

downwind exposure. .

that tesung showed that large concentrauons of it caused death within days. We have no informauon that
would make us conclude that Iraq used aflatoxin or that it was released in the atmosphere when bombing

occurred.

Other Potential Hazards

CIA's also reviewed intelligence on potential hazards other than chemical and biological agents. Some ot
the studied hazards include:

• Red Fuming Suric Acid (RFS'A). Scud missiles that impacted m Saudi .\rabia and Israel each
contamed approximately 300 pounds of toxic RFNA oxidizer and 100 pounds of kerosene fuel.
.Although we know of no long-term illnesses related to these chemicals, we assess that RFNA is a
likely cause of some of the bummg sensauons reported by veterans near Scud impacts. EXDD's
Persian Gulf Invesugauon Team (PGIT) has been informed of this and is following up to look for
long-term svinptoms.

• Radiological Weapons and Radiation Fallout. Although Iraq conducted research on radiological
weapons, we assess it never progressed into the developmental phase. Small quantities of radioacuve
material were released during tests m areas north of Baghdad. These tests took place two years before
the Gulf war, and any radioacuvity from those tests would have decayed away by the time of the war.
In addition, Iraqi nuclear faaliues bombed during the Gulf war produced only minimal local
contammauon north of the KTO, with no releases detected beyond those faciliaes.

• Miscellaneous. We have seen a number of reports claimmg that veterans were exposed to other
hazards including everything from poisoned water supplies to chocolate addiuves. In examming
these reports, we found nothing to corroborate them, but we have made DODs Persian Gulf
Investigative Team aware of them.

Future Efforts

CIA will continue to track any leads that surface in the future and will make our findings available to
the public. We will complete our review of the hazards posed by destruction of chemical rockets m
the pit area and will publish our findings over the Internet.

STATEMENT

MATTHEW L. PUGLISI. ASSISTANT DIRECTOR

NATIONAL VETERANS AFFAIRS AND REHABILITATION COMMISSION

THE AMERICAN LEGION

TO THE

JOINT SENATE VETERANS' AFFAIRS COMMITTEE AND

THE SENATE SELECT COMMITTEE ON INTELLIGENCE

UNITED STATES SENATE

REPORTS OF EXPOSURES OF US SOLDIERS TO CHEMICAL WARFARE
AGENTS DURING THE PERSIAN GULF WAR

SEPTEMBER 25, 1996

MATTHEW L. PUGLISI, ASSISTANT DIRECTOR

NATIONAL VETERANS AFFAIRS AND REHABILITATION COMMISSION

THE AMERICAN LEGION

TO THE

JOINT SENATE VETERANS' AFFAIRS COMMITTEE AND

THE SENATE SELECT COMMITTEE ON INTELLIGENCE

UNITED STATES SENATE

REPORTS OF EXPOSURES OF US SOLDIERS TO CHEMICAL WARFARE

AGENTS DURING THE PERSLVN GULF WAR

SEPTEMBER 25, 1996

Messrs. Chairmen and Distinguished Members of the Committees:

The American Legion would like to take the opportunity to submit testimony concerning
the exposure of US military personnel to low levels of chemical warfare agents during the
Persian Gulf over five years ago. We will address the effects that the Department of
Defense's inflexible policy concerning these exposures has had on the health care of ill
Gulf War veterans, and the research of Gulf War illnesses. We would also like to propose
a medical initiative that would address this issue in a manner consistent with the lessons
learned from the experience of Vietnam veterans exposed to the herbicide Agent Orange.

The American Legion realizes that today's hearing will focus on Defense Department and
intelligence reports of exposure of US soliders to chemical agents during the Persian Gulf
War. However, The American Legion would like to recommend that Congress address
the inadequacy of the United States military's chemical and biological warfare agent
detection and protection capabilities. This national security issue is extremely important to
veterans' health issues, especially since DoD has been reluctant to address the 'gapping
hole" in the nation's chemical and biological warfare defensive capabilities The American
Legion is concerned because DoD continues to purchase and deploy protection and
detection equipment which will not fiilly protect US military personnel from unhealthy low
levels of chemical warfare agents. The inadequate chemical warfare protection and
detection equipment is currently deployed with US forces in the Middle East, Korea and
Bosnia were large stock piles of chemical warfare agents are known to exist.

Over five years ago, while forcefully evicting the world's fourth largest army fi-om Kuwait,
American troops were exposed to chemical warfare agents. The evidence of these
exposures is overwhelming. DoD, however, continues to insist that American troops were
not exposed to chemical warfare agents in the Persian Gulf

The American Legion can only guess as to the reason for DoD's policy statements But
we do not have to spend much time in determining the effects that DoD's policy has had
on the heahh and well being of Gulf War veterans.

DoD's Comprehensive Clinical Evaluation Program (CCEP), a medical examination
program for Gulf War veterans on active duty, diagnoses 18% of its participants with a
psychological condition This can be compared with 7.1% of the general population who
seek medical care in the United States (CCEP Report on 18,598 Participants, April 2,
1996). Are we to believe that Gulf War veterans on active duty, after passing entrance
physicals, psychological screenings, and deployment physicals, are over twice as likely to
suffer from a psychological disorder as the average American civilian DoD has found an
epidemic of psychological disorders in its ranks, an epidemic found only among those who
come forward with health problems caused by their service in the Persian Gulf

The group of psychological disorders most commonly diagnosed in the CCEP are
Somatoform Disorders. According to the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (American Psychiatric Association, Washington, DC, 1994),
'the common feature of the Somatoform Disorders is the presence of physical symptoms
that suggest a general medical condition, and are not flilly explained by a general medical
condition [or] by the direct effects of a substance." (American Psychiatric Association,
1994, p. 445) The American Legion believes DoD's policy on exposures has encouraged
it's medical doctors to assign Somatoform Disorder diagnoses. One exposure that many
Gulf War veterans claim to have encountered, chemical warfare agents, was not present in
the Persian Gulf according to DoD The periodic pronouncements from DoD concerning
the nonexistence of 'Gulf War syndrome," combined with it policy on exposures, has
created an environment where DoD medical doctors believe that Somatoform Disorders
are more common among Gulf War veterans.

One illustrative example of the CCEP and DoD medical doctors' bias is that of a Gulf
War veteran from Connecticut. This veteran was diagnosed with between nine and eleven
diseases between 1991 and 1994 by the Army, and the Department of Veterans Affairs,
after his service as a helicopter pilot during the Gulf War. Yet, when he underwent a
CCEP examination during August of 1994, he was diagnosed with Somatization Disorder.
That was his only diagnosis. This one example illustrates what DoD's own statistics
demonstrate; the CCEP is biased against diagnosing disease in Gulf War veterans who
suffer from poor health as a result of their service in the Persian Gulf

DoD's policy has affected more than today's active duty servicemembers and veterans,
and their treatment by DoD medical doctors. It has affected how Gulf War illnesses is
being studied, the answers being sought, and our preparedness for future wars.

Exposed to many environmental hazards in the Gulf to include: smoke from oil well fires;
investigational medications, indigenous parasites; organophosphate pesticides, and stress,
thousands of Gulf War veterans have complained of poor health since their return from the
Gulf Their complex of health complaints has become popularly known as 'Gulf War
syndrome." One, many or all of the environmental hazards American troops were exposed
to in the Gulf could be the cause, of this illness, or illnesses. Dozens of well designed
scientific studies are underway to determine the role of these hazards in Gulf War

illnesses. One environmental hazard, however, is not currently under study. That one
hazard is low level chemical warfare agent exposure, its association with Gulf War
illnesses, and with disease in general. It is not being studied because the Department of
Defense has insisted that no American troops were exposed.

Due to lack of coordination between the three federal agencies most responsible in
determining the definition and etiology of Gulf War illnesses, DoD, VA and the
Department of Health and Human Services created the Persian Gulf Veterans
Coordinating Board. The Coordinating Board is responsible for selecting scientific studies
that examine the relationship between service in the Persian Gulf and illness in Gulf War
veterans. The Coordinating Board reviewed proposals this past winter, proposals fi-om
respected scientists fi"om around the nation, who wanted to examine specific exposures to
American troops in the Persian Gulf, and these exposures' association with disease.
Proposals for studies examining low level exposures to chemical warfare agents and
disease were not funded because DoD insisted that such exposures did not occur. We
have now learned that Gulf War veterans were right all along, and that these exposures did
occur. As of today, however, none of these studies are being funded, or are underway.

DoD's position has also prevented the scientific study of this issue by the federal
government The federal government is conducting dozens of scientific studies of its own
that have been underway for over a year. None of these studies are examining the
association between low level chemical warfare exposure and disease except one, and that
is in spite of DoD's policy.

In 1995, The Department of Veterans Affairs' Portland Environmental Hazards Center
proposed to the Coordinating Board that it conduct a study examining the association
between nerve agents and disease, but were dissuaded after the National Institutes of
Health Panel, in 1994, concluded that such exposures did not occur. The NIH Panel
based its conclusion solely on reports from DoD about such exposures. Today, we are all
well aware of the credibility and validity of DoD's prior reports concerning these
exposures. Portland did display some independence by choosing to study the association
between mustard gas and disease because, they concluded, DoD could not detect it well
with its equipment, and therefore, could not make reasonable claims that such exposures
did not occur (Testimony of Dr. Peter S. Spencer, Ph.D., FRCPath, before the Presidential
Advisory Committee on Gulf War Veterans' Illnesses in Boston, MA March 26, 1996).

Clearly, DoD's inflexible policy concerning exposures has adversely affected the medical
care of Gulf War veterans, and the scientific study of Gulf War illnesses. DoD coming
forward with information it has possessed for over five years, after denying that this
information existed, is shameful after one assesses the damage that their actions, or lack of
action, has done. Worst of all, after determining that as many as 5,000 Gulf War veterans
may have been exposed to chemical warfare agents near the Kamisiyah bunker alone, DoD
proposes that these veterans seek CCEP examinations. These are the same exams that
diagnose Gulf War veterans with psychological conditions at twice the national average.

Clearly, DoD's reaction to its recent admissions falls far short of the mark for Gulf War
veterans.

The American Legion does not offer this testimony merely to point out problems. We
offer this testimony with a solution that will address this issue in a bold manner, based on
sound science and medicine. We offer it in light of the lessons we all have learned from
our experience with veterans exposed to Agent Orange. The American Legion proposes
the following:

1 . The Department of Veterans Affairs should collect tissue samples (blood and fatty
tissue) from those believed to have been exposed to chemical warfare agents in the Persian
Gulf Participation would be voluntary, however, it would be encouraged through
extensive and comprehensive outreach. The tissue samples would be stored so that well
designed studies could occur in the future to determine the existence of markers in those
exposed to such agents.

2. Congress should establish a commission to investigate American troops' exposure to
chemical and biological warfare agents during or as a result of the Gulf War. This
commission would also monitor the collection of tissue samples from those suspected of
exposure, the storage of these samples, and the approval of any methods for examining
these samples in the fiiture.

This recommendation is consistent with the one offered to the Presidential Advisory
Committee on Gulf War Veterans' Illnesses by its staff on September 5, 1996. The staff
noted that DoD's policy and approach to chemical and biological warfare agent exposure
in the Persian Gulf has so undermined its credibility that an independent commission
should be created to investigate the issue. We recommend not only the creation of the
commission, but that it oversee the tissue collection effort.

Previous experience compels us to recommend the collection, storage and later re-
examination of these tissue samples. Despite early, widely quoted negative scientific
publications, retrospective estimates of exposure for both Ranch Hands and Vietnamese
civilians correlated reasonably well with recently developed biological markers. Such
markers and exposure estimates provide scientific strength to epidemiological studies,
even though specimens were not collected until ten years later. These results raise the
question whether biological specimens should be collected, stored, frozen in liquid
nitrogen, under the assumption that biological markers will be determinable at some future
date.

Of importance to The American Legion, the federal government, and Gulf War veterans is
the implication of improved exposure assessment. Because of the length of time since
their most recent exposure, exposure assessment of Vietnam veterans will remain difficult:
no tissue bank was established. This fact, and the recent scientific developments
concerning the identification of biomarkers due to past exposure to chemicals makes the
case that Gulf War veterans should have tissue and blood stored. This would allow at

some time in the future documentation or validation of exposure if a biological marker is
identified. Early attempts at developing such markers are underway. Human subjects
considerations become of great interest and may generate controversy. Stored samples of
biological tissue may be examined for the substance of interest to exposure assessment
but, at least theoretically, also for other substances such as drugs of abuse or for genetic
testing. These latter two may generate appropriate concerns for protection of privacy.
The commission proposed above would oversee the handling and testing of these samples,
alleviating the privacy concerns of the participants.

Tissue sampling will assess exposure levels without any smoke and mirrors from any
group or federal agency. The federal government, and the Congress, want what is best for
our veterans, while they wisely spend the taxpayers' money. Tissue sampling will one day
help determine who was exposed to chemical warfare agents in the Persian Gulf, and at
what levels they were exposed. In conjunction with well designed scientific studies that
examine the relationship between low level exposure to chemical warfare agents and
disease, we will be able to determine who fi-om the Gulf War was exposed, and know
what effects that exposure has, or will have. We may also be able to treat these veterans
at some future date based on this research.

Looking to the future, we have not seen the last of American troops and chemical warfare
agents. Unless the U.S. withdraws completely from the world, its troops will once again
face an adversary armed with chemical warfare agents. Now is the time to address the
lack of preparedness to fight such an adversary, and maintain the health of the troops that
do the fighting. Congress has an opportunity to address future challenges to tomorrow's
veterans, today. The American Legion encourages you to do so.

Department of Veterans Affairs

Under Secretary r3H Health
Washington DC 20420

JAN 21 1997

The Honorable Arleo Specter

Chainnan.

Committee on Vetcians' Affairs

United States Senate

Washington, DC 20510

Dear Mr. Chairman

I am writing in response to former Chairman Alan K, Simpson's October 28,
1996, letter regardi]ig my appearance before the Senate Committee on Veterans' Affairs
on September 25, 1996. As you requested, answers to the Committee's additional
questions are provii led below.

Question 1: The \'A set up the Persian Gnlf Registry to record the many ailments of
Persian Golf War veterans. In your opinion, how well has the Registry helped the
VA in its treatment of Persian Gulf War veterans?

Response: U.S. troops retuming from Operations Desert Shield and Desert Storm began
reporting a variety af illnesses which they initially attributed to inhalation of fijmes and
smoke from burning Kuwaiti oil-weU fires. In August 1992, in response to these
veterans' health coacems, VA initiated a health surveillance system, the Persian Gulf
Registry Health Ex amination Program.

The Persian Gulf Registry Health Examiaation Program offers a free, complete
physical examination with basic laboratory studies to any Persian Gulf veterans. A
complete medical liistory and interview are also performed and documented in the
veteran's medical i-ecord. To date, more than 62,000 veterans have responded to VA's
outreach encouraging them to participate. VA maintains a centralized registry, or list of
participants who have had these examinations. This clinical database is called the Persian
Gulf Veterans Health Registry. Specifically, the Registry:

• allows VA to I cmmunicate with Persian Gulf veterans by informing them of new
programs, research findings, or compensation policies through periodic newsletters;

• helps VA respond to veteran's health concerns;

The Honorable Arlt o Specter

• provides a surviiUajoce mechanism to catalogue prominent symptoms and diagnoses;
and

• allows VA to c< )iicentrate education eflforts on a special group of adroinistrative
coordinators and Registry physicians. Each VA medical facility has a designated
coordinator anci Registry physician who act as a source of information to veterans and
other VA healtl icare providers.

In sum, I believe it has been of substantial benefit to us in treating these veterans.

Qaestion 2: Of the symptomatic Persian Calf veterans on the Registry, doyou
know how many iire claiming their symptoms are related to low-level chemical
exposores?

Response: The se If-reported exposure history of 758 veterans on VA's Revised Persian
Gulf Registry computer database shows 1 1% who rqjorted that they believed they had
exposure to nerve :>as, 25% reported they had not been exposed to nerve gas, and 64%
did not know if they had been exposed to nerve gas. Six percent of this group reported a
beUef that they were exposed to mustard gas, 37% reported they had not been exposed to
mustard gas, and 57% did not know if they had been exposed to mustard gas. "While the
original registry c< )de sheet did not track veteran reported exposures, the revised
questionnaire has i)een mailed to the approximately 53,000 veterans who received
examinations prioi; to the revision. This information will be incorporated into the
computerized database.

Qaestion 3: The Department of Defense is developing a Geographic Information
System (GIS). It will be a comprehensive registry of troop movement during the
Persian GuIfWar. It win be an immensely important tool in identifying legitimate
exposures and le^tlmate service-connected disability claims. Do yon have any
research studies that await completion of GIS? Have the DoD and VA developed a
protocol by which VA researchers can have access to the GIS?

Response: VA i) ivestigators with Internal Review Board (IRB)-approved research
projects have access to information currently available from the GIS. There is good
cooperation betwijen VA and the GIS team. VA's Boston Environmental Hazards
Research Center Jias already been granted access to GIS infoimation. VA does not have
any research studies that await final completion of the GIS database. The value of the
GIS A?fi* is limited because it does not contain information on location of individual
soldiers or locatidn information before January 1991. •

The Honorable Arka Specter

Question 4: Tbe \ A has completed the first phase of the "National Health Survey of
Persian GalfVetei ans and Their Families." The VA mailed oat a postal survey to
15,000 Gulf War veterans and 15,000 Golf era veterans. I nnderstand that the
response rate to th e initial mail survey was 56 percent What are your impressions
as to '(vhy 44 percent of those contacted did not respond to the mail survey? Did the
VA have current addresses causing the surveys to be "Returned to Sender^ Or is
there a tendency for healthy veterans not to respond to the survey? I would believe
a healthy veteran ^vould be less likely to respond to the survey than a sick one.

Response: The pejcentage of veterans completing and returning the "National Health
Survey of Persian (hllf Wax Veterans and Their Families" is typical of the expected
response rate to mail surveys of this type. We agree that healthy individuals would be
less likely to complete the Phase I questioimaire than people who are ill Also, non-
Pexsian Gulf vetcraaa are probably less likely to respond to the survey than those who
actually served in t lie Persian Gulf.

The Phase II, a telephone foUow-up survey to non-respondents, is designed to
correct for and assi;ss the degree of bias introduced by non-response. This phase of the
National Survey is currently underway.

VA utilized various databases, including VA and Internal Revenue Service (IRS)
sources, to provide- the addresses used for the questionnaire mailing labels. In addition,
the investigators engaged an outside contractor to locate the addresses of individuals
whose surveys wei^e returned to \is stamped "Retumed to Sender." Despite these efforts
approximately 5% of the questionnaiies were still returned by the U.S. Postal Service due
to incorrect addrej^ses. Another outside contractor will conduct telephone interviews with
the 8,000 veterans who did not respond to the mail questionnaire, as part of Phase n of
this project.

Thank you for the opportunity to provide additional information on these
important issues. Please contact me if you should require any fiirther assistance.

Sincerely yours,

Kenneth W.-Kizer, M.D., M.P.H.

Department of
Veterans Affairs

ANNUAL REPORT TO CONGRESS

Federally Sponsored Research on
Persian Gulf Veterans' Illnesses for 1995

The Research Working Group of the Persian Gulf Veterans Coordinating Board

Table of Contents
INTRODUCTION 3

RESEARCH MANAGEMENT - 3

Overview OF Research Management 3

Oversight OF Research 4

Research Coordination 5

EVENTS AND MILESTONES IN 1995 6

Devtlopment of a Working Plan for Research of Persian Gulf Veterans' Illnesses 6

DODA/A Solicitation OF New Research Projects 9

Meeting OF Researchers AT Armed Forces Instttute OF Pathology 9

Meeting OF THE American Public Health Association 10

Milestones in Three Major Epidemiologic Research Efforts 10

I'A National Health Survey of Persian Gulf Veterans JO

The Health Assessment of Persian Gulf War Veterans from Iowa 10

Epidemiologic Studies of Morbidity Among Gulf War Veterans: A Search for Etiohgic Agents and Risk
Factors 10

STATUS OF COMPLETED AND ONGOING RESEARCH. 11

Ontrview 11

Noteworthy Research Results 14

Comparative Mortality Among US Military Personnel Worldwide During Operations Desert Shield and

Desert Storm - Department of Defense 14

Mortality Follow-up Study of Persian Gulf Veterans - Department of Veterans Affairs 14

Suspected Increase of Birth Defects and Health Problems Among Children Born to Persian Gulf
Veterans in Mississippi - Centers for Disease Control and Prevention/State of Mississippi Department

of Health 15

Centers for Disease Control and Prevention (CDC) Investigation of Veterans in Pennsylvania - Centers

for Disease Control and Prevention 15

Epidemiological Studies of Morbidity Among Gulf War Veterans: A Search for Etiologic Agents and

Risk Factors - Department of Defense, Naval Health Research Center 16

Biomarkers of Susceptibility and Polycyclic Aromatic Hydrocarbon (PAH) Exposure in Urine and
Blood Cell DNA from U.S. Army Soldiers exposed to Kuwait Oil Well Fires - National Institutes of

Health " 17

Acute Oral Toxicity Study of Pyridostigmine Bromide, Permethrin, and DEET in the Laboratory Rat -

Department of Defense 17

Summary OF Current Findings 18

EXPECTED MILESTONES IN 1996 ......19

Research Accomplishments 19

Other Milestones 19

REFERENCES „ „ 20

APPENDICES

APPENDIX A - A Working Plan for Research on Persl^jm Gulf Veterans' Illnesses - Aug. 1995

APPENDIX B - Persian Gulf Veterans' Illnesses Research Database

APPENDIX C - Topical Bibliography Of Published Works Regarding The Health Of Veterans

Of The Persl^ Gulf War Illnesses

APPENDIX D - Abstracts from Annual American Public Health Association Meeting

APPENDIX E - List of Research Papers and Reports

APPENDIX F - Reprints of Relevant Peer Reviewed Research Papers

INTRODUCTION

On August 31, 1993, in response to Public Law 102-585, President Clinton named
the Department of Veterans Affairs (VA) as the lead agency for research into the health
consequences of service in the Persian Gulf War. As part of its role as the lead research
agency VA is required to submit to Congress an annual report on the results and progress
of federally Junded Kseaich on Persian Gulf veterans' illnesses. This is the third of these
annual reports. Because this document is a status report, and because it is restricted only
to federally funded research, it does not attempt to interpret the aggregation of current
research findings.

In addition to the research efforts highlighted in this report, there have been several
noteworthy research efforts in the private sector. Most recently, studies of infectious
agents, pyridostigmine bromide, and other clinical issues have been reviewed by the
Persian Gulf Veterans Coordinating Board. VA, DOD, and HHS senior clinical and
research managers have met with interested non-federal investigators to be fially informed
on (their) study outcomes. However, these private sector research efforts are not included
in this report because this document is a status report on i\\t federally funded research on
Persian Gulf Veterans Illnesses.

This report is divided into four sections. The first section discusses the
management of federal Persian Gulf veterans' illnesses research programs, including
research oversight, peer-review and coordination. The following section highlights
significant research events and milestones in the last year. The next section summarizes
the status and results fi-om several important research projects and programs of the federal
government (Appendix C contains a comprehensive listing of all research projects and
programs conducted or sponsored by the federal government). The final section lists
significant milestones anticipated for 1996.

RESEARCH MANAGEMENT
Overview of Research Management

Research on Persian Gulf veterans' illnesses is complex, involving a number of
different approaches and outcomes. The federal research enterprise involves scientists
conducting research sponsored by VA, the Department of Defense (DOD), and the
Department of Health and Human Services (HHS). Each of these Departments have
distinct, though complementary, capabilities and capacities for conducting and sponsoring
research on Persian Gulf veterans health issues. Each Department has its own
appropriation for extramural and intramural general biomedical research programs The
Department of Defense also has a separate item in its appropriation for DODA'^A
collaborative research on health problems shared by veterans and active duty service
members alike.

The biomedical research programs in VA, DOD, and HHS have well established
management structures for science policy formulation and the solicitation, scientific peer
review, and fiinding of both extramural and intramural programs. The coordination and
management of research on Persian Gulf veterans' illnesses has required the establishment
of an overall research policy fi-amework linking each Department's research management

hierarchy The link ge is provided through the Research Working Group of the Persian
Gulf Veteran's Coordinating Board As an operation policy, the Research Working
Group works through the line management authority each department maintains over its
intramural scientists, scientific program managers (responsible for extramural research),
and their budgets

Oversight of Research

Each Department engaged in research on Persian Gulf veterans' illnesses
emphasizes the need for both prospective and retrospective peer review of research.
Because of the urgency of the health concerns of Persian Gulf veterans and their families,
as well as the diverse nature of the reported illnesses, review and oversight of research is
essential. VA, DOD, and HHS have established multiple oversight mechanisms to capture
the diverse nature of the overall effort, some oversight mechanisms are broad-based,
encompassing all research issues, whereas others are more focused on individual research
projects and programs

Institute of Medicine/Medical FoUow-up Agency (under contract to VA and DOD):
Healtit Consequences of Persian GulfSennce

In 1993 VA and DOD jointly entered into a 3 year contract with the Medical
Foliow-Up Agency (MFUA) of the Institute of Medicine (lOM), National Academy of
Sciences CNAS) The lOM was charged with reviewing e?dsting scientific, medical and
other information on the health consequences of military service in the Persian Gulf area
during the Persian Gulf War The lOM was also to review the research activities and
plans of the various involved agencies and make recommendations The lOM Committee
on the Health Consequences of the Persian Gulf War released its interim report in January
1995 (lOM. 1995) and will make its final report in September 1996

In its Interim Report, the lOM made several recommendations to VA and DOD to
improve their research programs on Persian Gulf veterans' illnesses In testimony
delivered on March 1 1, 1996 to the Subcommittee on Human Resources and
Intergovernmental Relations of the House Committee on Government Reform and
Oversight, Dr John Bailar, Chairman of the lOM Committee on the Health Consequences'
of the Persian Gulf War, stated that VA and DOD "...have largely acted in accord with our
recommendations, and I am personally pleased with the progress that has been made to
date ""

Department of Veterans Affairs: Persian Gulf Expert Scientific Committee

In late 1993 \'A chartered this standing federal advisory committee at the request
of VA Secretary' Jesse Brown The purpose of the VA Expert Scientific Committee is to
advise the VA Under Secretar>' for Health and the Assistant Chief Medical Director for
Public Health and Environmental Hazards on medical findings affecting Persian Gulf
veterans The Committee also reviews research activities The Committee consists of 18

members selected on the basis of high professional achievement, expenise in illnesses
which might be related to Persian Gulf service, and research expertise in these areas The
Committee has met seven times since early 1994 and has heard presentations from
numerous scientists and clinicians. Tne deliberations of the Committee have provided a
continuous review of VA clinical and research programs

Executive Office of the President: Presidential Advisory Committee on Gulf War
Veterans' Illnesses

The President established this advisory committee by Executive Order on May 26,
1995 The 12 member committee is composed of scientists, health care professionals,
veterans, and policy experts The Committee is charged with reviewing and providing
recommendations on the full range of government activities relating to Persian Gulf
veterans' illnesses The full Committee has met five times and subcommittees reviewing
clinical and research issues have met three times Each meeting has had public comment
periods and invited presentations from clinicians, scientists, veterans, and government
officials

The Committee released an interim report in Februar\- 1996 Although the Interim
Report stated that VA. DOD, and HHS research programs are generally well designed and
should lead to answers, it also had several recommendations The Committee's
recommendations covered issues such as peer review, coordination of agency research
activities, the use of public advisory' committees and the availability of information on
troop exposure The agencies have developed a coordinated plan of action (The Persian
Gulf Veterans Coordinating Board, 1996) that responds to the Advisory Committee's
interim recomendations The agencies will also respond to the recommendations
contained in the final report, which is scheduled for release in December 1>96.

Other Oversight

In addition to the broad oversight provided by the three committees cited above,
there are several standing and special committees responsible for oversight on individual
research projects and programs Projects and programs receiving continuous or ad hoc
oversight include:

• The National Health Survey of Persian Gulf Veterans (VA)

• Epidemiologic Studies of Morbidity Among Gulf War Veterans: A Search for
Etiologic Agents and Risk Factors (DOD)

• Health Assessment of Persian Gulf War Veterans from Iowa (HHS)

• Each of the three Environmental Hazards Research Centers (VA)

Research Coordination

In 1993, VA, DOD. and HHS recognized the importance of a coordinated
approach to research on Persian Gulf veterans' illnesses In response to this need the
three Departments formed the "Persian Gulf Interagency Research Coordinating Council"

By January 1994, when the Secretaries of V ;, DOD, and HHS formed the Persian Gulf
Veterans Coordinating Board, the Council became the Research Working Group
operating under the auspices of the Coordinating Board (Beach et al, 1995) Because of
the potential link between environmental factors and Persian Gulf veterans' illnesses, the
Environmental Protection Agency was asked to be a member of the Research Working
Group

The Research Working Group is charged with assessing the state and direction of
research, identifying gaps in factual knowledge and conceptual understanding, identifying
testable hypotheses, identifying potential research approaches, reviewing research
concepts as they are developed, collecting and disseminating scientifically peer-reviewed
research information, and insuring that appropriate peer review and oversight are applied
to research conducted and sponsored by the federal government Membership on the
Research Working Group consists of senior research and clinical managers from VA,
DOD, HHS, and EPA To carry out this function, the Research Working Group meets at
least monthly

EVENTS AND MILESTONES IN 1995

Development of A Working Plan for Research of Persian Gulf Veterans'
Illnesses

Assessments in 1994 of existing knowledge and data by the Defense Science
Board Task Force (DSB). a National Institutes of Health Technology Assessment
Workshop (NIH, 1994), and the National Academy of Sciences/Institute of
Medicine/Medical Follow-up Agency (lOM) led the Research Working Group to the
conclusion that significant investments in research would be required to ascertain the
nature, extent, and causes of illnesses among veterans of the Persian Gulf War Although
close coordination of research activities were taking place among investigators in VA,
DOD, and HHS. it was determined that a written research plan encompassing the Federal
research effort needed to be developed If constructed properiy, such a research plan
would ensure that appropriate research questions are addressed, while at the same time
avoiding unnecessary' duplication In 1995 a subcommittee of the Research Working
Group was formed to draft A Working Plan for Research on Persian Gulf Veterans '
Illnesses The members of this subcommittee were senior research and clinical managers
with expertise in clinical research, epidemiology, and toxicology The final research plan
was approved by the full membership of the Research Working Group and concurred
upon by top management of VA, DOD, and HHS in August 1995.

As a starting point the subcommittee examined the valuable data assessments and
research recommendations developed by the Defense Science Board Task Force (DSB,
1994), the NTH Technology Assessment Workshop (NTH, 1994), and the Institute of
Medicine (lOM. 1995)

In defining the course of research three goals for research were established;

1 Establishment of the nature and prevalence of symptoms, diagnosable

illnesses and unexplained conditions among Persian Gulf veterans in
comparison with appropriate control populations.

2. Identification of possible risk factors for any illnesses found among Persian
Gulf veterans,

3. Identification of appropriate diagnostic tools, treatment methods, and
prevention strategies for illnesses found among Persian Gulf veterans.

To the extent appropriate and feasible, these goals would also apply to veterans'
family members

The overall approach to development of the plan involved: identification of the
knowledge required to reach the above goals, identification of the knowledge either
currently available or obtainable fi^om ongoing research programs; and lastly identification
of additional research areas necessary to close the gap between what is known and what is
needed. In identifying the required knowledge, the subcommittee developed a set of 19
research questions The first research question set the stage for all others: What is the
prevalence of illnesses (wawfesied by signs and or symptoms) in the Persian Gulf
veterans population'^ Hom' does this prevalence compare to that in an appropriate
control group"^

Illnesses occur in any population over time, but it is currently not known whether
Persian Gulf veterans are experiencing illnesses beyond those expected in such a
population of relatively young, fit men and women The Persian Gulf registries of both
VA and DOD cannot alone answer this question The registries are important tools for
observing trends in reported symptoms and illnesses, and for developing research
questions. As the research plan identifies, there are several ongoing and planned
epidemiologic investigations that address this question Important among these are the
VA National Health Survey, the VA Mortality Study, the epidemiologic studies of the
Naval Health Research Center in San Diego, and the CDC studies of Iowa veterans and
Pennsylvania Air National Guardsmen

If these studies demonstrate in aggregate an increased prevalence of illnesses, then
secondary questions regarding disease entity or entities must be addressed The plan
identifies 18 secondary questions The questions are divided between exposure-related
questions and health outcome-related questions. This was done to isolate two broad,
interconnected questions: (1) what was the nature and extent of possible exposures
experienced by veterans while in the Persian Gulf and (2) what specific adverse health
outcomes have occurred among Persian Gulf veterans, beyond those normally expected in
such a large adult population'' These two questions lead to a third question, namely: (3) is
there a relationship, or set of relationships, between exposure to the complex environment
of the Persian Gulf theater and any excess morbidity and mortality fi"om epidemiological
data that is consistent with established biological and toxicological principles'' This last
question needs to be addressed by investigating both exposures and health outcomes.
Investigations of exposures can lead to hypotheses about expected health outcomes based
on the nature and extent of the exposures, and investigations of health outcomes can lead
to hypotheses about exposures.

The exposure-related questions and the outcome-related questions were generated
in large measure by a critical examination of the findings of the DSB (DSB, 1994), NIH
(NIH, 1994), and lOM (lOM, 1995) panels This approach was important and was

endorsed by the Research Working Group It built on the very substa itial intellect lal and
financial capital invested in these three distinguished panels.

The subcommittee first categorized the exposure and outcomes areas of concern
considered by the panels Exposure areas of concern identified by the three panels were:

Infectious agents

Smoke fi"om oil well fires/oil spills

Other petroleum product exposures

Other occupational exposures

Potential chemical and biological warfare agents

Vaccines

Pyridostigmine bromide

Psychological stressors of war

Health outcomes of concern identified by the three panels were;

Non-specific symptoms/symptom complexes
Immune function abnormality
Reproductive health outcomes
Genitourinan,' disorders
Pulmonary fijnction abnormalities
Neuropsychological outcomes
Leishmaniasis
Neoplastic disease
Mortality outcomes

The subcommittee then assessed the importance placed on each arcu of concern by
the three panels .Areas of clear consensus among the panels on exposures and outcomes
were identified and issues for fijture research were then pnoritized based on scientific
merit In areas of disagreement among the panels the subcommittee discussed the
scientific merits of each view and made a decision as to its pnonty. Generally, the
subcommittee included most exposure and outcome areas where the panels disagreed
Not all areas were considered by all panels. In such cases an inclusive view also prevailed

The mdividual research questions are enumerated in the Working Plan (Appendix
A) Many of these research questions are being addressed by ongoing research and much
of that research is focused appropriately along epidemiological lines The research plan
delineates some specific areas of inquiry needing special emphasis:

• Information on the prevalence of illnesses and diseases within other
coalition forces,

• Information on the prevalence of symptoms, illnesses and diseases
within indigenous populations living in the Persian Gulf area, including
Saudi Arabia and Kuwait,

• Information on the prevalence of adverse reproductive outcomes
among Persian Gulf veterans and their spouses,

• Simple and sensitive tests for L. tropica infection that could lead to
quantitation of the prevalence of I. tropica infection among Persian
Gulf veterans, and

• Information on the long-term, cause-specific mortality among Persian
Gulf veterans.

The research plan was released publicly on August 4, 1995. It has received broad
distribution, including publication on DOD's Gulflink home page on the World Wide Web

DOD/VA Solicitation of New Research Projects

The areas of specific inquiry identified at the end of the Working Plan were used
by DOD in a solicitation for proposals contained in a Broad Agency Announcement in
June 1995 Over 100 proposals were reviewed for scientific merit by external peer-review
panels After ratings were assigned by the peer-review panels, summary review statements
(redacted for investigator and institutional identifiers) were provided to a subcommittee of
the Research Working Group (some subcommittee members were government officials
fi"om outside of the Research Working Group) for the purpose of evaluating proposals for
their relevancy to the research needs established by the Working Research Plan The
subcommittee was not responsible for any ftirther scientific review, and relied on the
scientific merit scores established by the independent, scientific peer-review panels The
overall goal of the subcommittee was to identify the proposals that had the highest
scientific merit and met the research needs established in the Working Research Plan The
subcommittee developed its recommendations and provided them to the Research
Working Group for endorsement The Research Working Group transmitted the
recommendations to DOD through the Persian Gulf Veterans Coordinating Board The
Department of Defense is currently finalizing negotiations with the offerors By the end of
negotiations, it is anticipated that approximately 12 new research projects v. ill be funded

Meeting of Researchers at Armed Forces Institute of Pathology

The Research Working Group of the Persian Gulf Veterans Coordinating Board
organized an informal meeting of federal government scientists and federally sponsored
scientists engaged in research on Persian Gulf veterans' illnesses The meeting took place
on June 14-15, 1995 at the Armed Forces Institute of Patholog>'. The purpose of the
meeting was to provide scientists with a forum at which they could informally share
problems, concerns, areas of commonality, and preliminary findings

The first morning of this two day meeting was devoted to presentations on
ongoing research related to the health of Persian Gulf veterans. Following the
presentations, participants were broken into three working groups: epidemiology,
toxicology, and clinical research The groups were charged with discussing the major
issues with each of the working group areas. Groups were asked to document their
discussions and present any recommendations to the whole assembly.

The meeting was an important step in bringing researchers together to help ensure
overall coordination of the federal research effort.

Meeting of the American Public Health Association

A session of the Annual Meeting of the American Public Health Association
(APHA) was devoted to epidemiologic research on Persian Gulf veterans' illnesses. The
Meeting was held October 3 1 in San Diego, CA. Twelve papers on Persian Gulf veterans'
illnesses were presented which included preliminary results of completed investigations
and methodological approaches to planned and ongoing studies. Appendix D contains the
abstracts of these presentations Some of the preliminary results presented at the APHA
are described in the section on research status.

IVIilestones in Three Major Epidemiologic Research Efforts
VA National Health Survey of Persian Gulf Veterans

The data collection phase of the VA National Health Survey of Persian Gulf
Veterans began in 1995 The survey underwent extensive peer-review from a
subcommittee of VA's Expert Scientific Panel, and was fijrther reviewed by the Office of
Management and Budget Details of the survey are provided below

Sur\'ey questionnaires were sent to 30,000 Persian Gulf veterans in November
1995. A second follow-up mailing was sent out in January 1996. This phase of the
National Health Survey should be complete by May 1996 VA plans to conduct two more
phases of the study, a telephone interview and physical examinations, and hopes to
complete the National Health Sur^■ey by Spring 1998

The Health Assessment of Persian Gulf War Veterans from Iowa

Data collection has begun on a telephone survey of self-reported health
assessments in a stratified random sample of approximately 3000 Iowa veterans divided
into four study groups active duty service members deployed to the Persian Gulf,
National Guard and reserve service members deployed to the Persian Gulf, non-deployed
active duty service members of the Persian Gulf era; and non-deployed National Guard
and reserve service members of the Persian Gulf era Results from this study are expected
by Summer 1996 This program is being conducted by the Iowa Department of Public
health in conjunction the University of Iowa through a cooperative agreement with the
CDC

Epidemiologic Studies of Morbidity' Among Gulf War Veterans: A Search for
Etiologic Agents and Risk Factors

This large program is being conducted by the Naval Health Research Center.
Overall, seven epidemiologic studies are underway. Study 1 is a cross sectional study of
1,500 Seabees (Navy construction workers) that compares post-war morbidity among
those who were deployed to a non-deployed control group Study 2 is a comparative
study of DOD hospitalization records for deployed and non-deployed active duty
personnel from the Persian Gulf era. About 1 .2 million service members are involved in
this re\iew of hospitalization records which compares the hospitalization experience

between deployed and non-deployed active duty personnel from the Persian Gulf era.
Study 3 utilizes the same data base as study 2 to compare birth outcomes in spouses of
active duty service members deployed to the Persian Gulf with non-deployed service
members. Study 4 is a survey of married couples in which at least one spouse was
deployed during the Persian Gulf War. The survey is intended to ascertain pregnancy
outcomes (premature birth and spontaneous abortions) and reproductive success
(infertility) Approximately 21,000 couples wnll be surveyed. Study 5 is a large-scale
survey of all 17,000 Seabees who were on active duty during the Persian Gulf War,
including those who have left military service. The objective is to identify any latent health
effects among Persian Gulf veterans Study 6 is a study of hospitalization records in non-
federal hospitals in California as a measure of health in those who have left military
service Study 7 is an examination of several state birth defects registries to compare the
rate of birth defects in offspring of deployed Persian Gulf veterans (spouses) with that in
offspring of non-deployed Persian Gulf veterans

STATUS OF COMPLETED AND ONGOING RESEARCH

Overview

Appendix B comprises the current contents of the Persian Gulf Veterans' Research
Database This database was last updated during the first quarter of FY'96 Research
projects are grouped according to the Depanment that is responsible for the conduct or
sponsorship of the research

Each entry in the database includes

Project Title

Responsible Federal Agency

Study Location

Project Start-up Date

Project Completion Date (estimated if ongoing)

Overall Objectives of Project

Specific Aims of Project

Methods of Approach

Expected Products (Milestones)

Current Status Results

Publications

Virtually all current federal research directly related to Persian Gulf veterans'
illnesses is sponsored by VA, DOD, or HHS. These three Departments currently sponsor
69 distinct research projects on Persian Gulf veterans' illnesses, of which 51 are ongoing,
and 18 are complete . This does not count the approximately 12 new research programs
to be fijnded by DOD as a result of a Broad Agency Announcement issued last year. Nor
does it count research proposals currently before VA's Medical Research Service Merit
Review Committee VA alone is conducting or sponsoring 35 projects, of which 27 are

A project is considered complete when all data have been collected and ana]>zed There will be a delay

bet\\een completion and publication of results to allow for adequate scientific peer-re\iew.

ongoing and 8 are complete Most of the large research projects and programs, such as
the large epidemiology studies and VA's three Environmental Hazards Research Centers
(encompassing 14 projects alone), involve some participation of VA, DOD, HHS, and
EPA

The scope of the federal research portfolio is very broad In size, projerts range
from small pilot studies utilizing limited or no direct appropriated research funds, up to
large-scale epidemiology studies and major research center programs utilizing significant
amounts of appropriated research funds

The areas of current research focus are categorized as follows:

PREVALENCE AND RISK FACTORS FOR SYMPTOMS AND
ALTERATIONS IN GENERAL HEALTH STATUS

BRAIN AND NERVOUS SYSTEM FUNCTION

EWTRONMENTAL TOXICOLOGY

REPRODUCTH E HEALTH

DEPLETED URANIUM

LEISHMANIASIS

IMMUNE FUNCTION

PYRIDOSTIGMINE BROMIDE

MORTALITY EXPERIENCE

MISCELLANEOUS

Within each of these focus areas there may be several different approaches
Approaches range in type from basic research, addressing potential biological mechanisms
of causation, to clinical and epidemiological research that attempts to ascertain illness
prevalence and risk factors Although precise categorization of research types can be
difficult because of overlapping methodologies, Persian Gulf veterans' illnesses research
projects can be divided into the following general types

BASIC RESEARCH: encompasses research into mechanisms of disease using ///
vitro and ni vivo models in humans and laboratory animals

CLINICAL RESEARCH: application of an intervention, such as in a controlled
drug trial

CLINICAL EPIDEMIOLOGY: uses epidemiological techniques focused on
specific disease or syndrome outcomes Most case-control studies fall under this
cateeorw

EPIDEMIOLOGY RESEARCH: includes population-based studies focused on
outcomes such as mortality, symptoms, hospitalizations, etc., using devices such as postal
surveys, telephone interviews, and records reviews

APPLIED RESEARCH: application of known scientific principles to a specific
objective such as vaccine or drug development.

Appendix B classifies all research projects by focus area and within each focus area
by the type of approach At the end of Appendix B Gant charts are provided graphically
depicting the projected timelines on cataloged research projects. It should be emphasized
that these timelines represent current projections and are subject to change.

The Persian Gulf Veterans' Illnesses Research Database catalogs only research
which is deemed to be directly related to the health problems of Persian Gulf veterans
The database takes no account of the vast accumulated knowledge derived fi^om the
nation's investment in the biomedical research enterprise of the last 40 years.

Lastly, the Persian Gulf Veterans' Research Database only contains research that is
federally sponsored This includes research conducted by federal scientists, as well as that
by non-federal scientists supported by federal research ftinds through grants and contracts
It is not possible to ensure that all research efforts are tracked that fall within the private
sector or otherwise outside of the purview of the federal government Notwithstanding,
the Research Working Group attempts to stay abreast of all research relevant to Persian
Gulf veterans" illnesses The Research Working Group accomplishes this by monitoring
the peer rexiewed published scientific literature, attending scientific meetings, and even
using newspaper repons and word-of-mouth The Research Working Group has used
these methods to identifS researchers, for example, from M D Anderson Cancer Center in
Houston, Texas. Duke University m Durham, North Carolina; and the University of Texas
Southwest Medical Center in Dallas, Texas who are conducting non-fedeially sponsoreo
research related to Persian Gulf veterans' Illnesses Investigators fi"om these institutions
were invited and presented their research to the Research Working Group in Washington,
DC during 1995

Regardless of the entity that supports particular research projects, all research that
has undergone rigorous peer review and has been published in peer reviewed scientific
literature will ultimately be used in formal assessments of nature and cause(s) of Persian
Gulf veterans' illnesses

100

Noteworthy Research Results

In the prior year there have been several research projects which have begun to
produce results that provide a preliminary, albeit tentative, view of the health problems of
Persian Gulf veterans This section provides brief descriptions of these research projects
and their results Publications resulting from these projects are bsted in Appendix E and
copies of key peer reviewed papers are in Appendix F Some preliminary results of
several research projects were presented at the Annual Meeting of the American Public
Health Association (APHA) held in San Diego, CA, in October 1995.

It must be stressed that results from each one of these projects alone cannot be
used to draw generalizable conclusions regarding the health of Persian Gulf veterans and
their family members Each study has addressed, or is currently addressing, focused
research questions which in some cases were directed at specific subpopulations of Persian
Gulf veterans As additional research studies are completed and their results enter the
scientific literature, a more complete synthesis of results will be feasible.

Comparative Mortality Among US Military Personnel Worldwide During
Operations Desert Shield and Desert Storm - Department of Defense

This study examined the disease and non-battle injury (DNBI) mortality experience
of all US militaP)' personnel during a 1 year period which included the Persian Gulf War.
The DNBI death rates among militar\' personnel deployed to the Persian Gulf were not
increased when compared to non-deployed personnel There was also no evidence of
clusters of unexpected deaths (Writer. 1996)

Mortality Follow-up Study of Persian Gulf Veterans - Department of Veterans
Affairs

The cause-specific mortality experience of 695,292 service members deployed to
the Persian Gulf during Operations Desert Shield/Desert Storm between August 1990 and
April 1991 was compared to 746,038 non-deployed U.S. service members (Kang et al,
1995). Follow-up on these veterans began on May 1, 1991, or the date they left the
Persian Gulf area alive, and ended on September 31, 1993 During the defined period
there were a total of 1,765 deaths from all causes among deployed veterans while the
number expected in a comparable U.S civilian population was 4,01 1 . The observed
deaths due to all causes among deployed Persian Gulf veterans was, however, greater
than that in a comparable non-deployed military population during that same period.
These excess deaths among deployed veterans are primarily attributed to external causes
including all accidents and motor vehicle accidents No excess deaths were observed for
suicide and homicide among the Gulf veterans. When deaths due to accidents, suicide, and
homicide (external causes) were excluded (leaving only disease-related causes of death),
the number of deaths among deployed veterans was 543 while the number expected was
624 based on the mortality rate among the non-deployed veterans. The computed
disease-related death rates using these data are not different between deployed and non:

101

deployed veterans Despite the difference in overall mortality between deployed and non-
deployed veterans, the mortality risk from all causes for deployed veterans was still less
than half of what was expected from a comparable US population during the same
period The Department of Veterans Affairs plans to conduct further mortality follow-up
studies at appropriate time intervals.

Suspected Increase of Birth Defects and Health Problems Among Children Born to
Persian Gulf Veterans in Mississippi - Centers for Disease Control and
Prevention/State of Mississippi Department of Health

In late 1993 there was a report of an apparent cluster of birth defects and other
health problems among children bom to veterans of two Mississippi National Guard units
that had been deployed to the Persian Gulf during Operations Desert Shield/Desert Storm
The Department of Veterans Affairs in Jackson, Mississippi, the Mississippi State
Department of Health, and the Centers for Disease Control and Prevention conducted a
collaborative investigation to determine whether an excess number of birth defects
occurred among children bom to this group of veterans Investigators reviewed the
medical records of all children conceived by and bom to veterans of these two units after
deployment to the Persian Gulf The total number of major and minor birth defects was
not greater than expected Limitations of statistical power due to the small number of
births (54) prevented the drawing of conclusions about the occurrence of specific birth
defects. The frequenc>' of premature birth and low birth weight also appeared similar to
that in the general population (Penman et al, 1996).

Centers for Disease Control and Prevention (CDC) Investigation of Veterans in
Pennsylvania - Centers for Disease Control and Prevention

In November 1994 the Department of Veterans Affairs, Department of Defense,
and the Pennsylvania Department of Health requested that the CDC investigate a report of
illnesses among members of an Air National Guard Unit The CDC conducted a three
stage investigation to: 1) characterize signs and symptoms among in the veterans of this
unit who were being seen at a local VA medical center, 2) determine whether the
prevalence of symptoms was higher among members of this unit compared to other
deployed and non-deployed units, and 3) characterize illnesses and identify risk factors.
At this time, stages 1 and 2 have been completed

In the first stage 59 symptomatic Persian Gulf veterans from the VA Medical
Center in Lebanon, PA, were interviewed and received standard physical exams Twenty
six of the veterans were selected from the VA Persian Gulf Registry, 14 were typical cases
identified by the reporting VA physician, and 1 9 were listed on the VA Persian Gulf
Registry but had not been evaluated by the VA medical center. Of the 59 veterans, 30 had
been assigned to the index unit. A variety of symptoms were reported, including: fatigue,
joint pain, nasal or sinus congestion, diarrhea, joint stiffness, unrefreshing sleep, excessive
gas, difficulty remembering, muscle pains, headaches, abdominal pains, general weakness,
and impaired concentration

102

] I the second stage, members of the index unit and three compa ison units were
surveyed to determine the prevalence of selected symptoms identified in stage 1 The
three comparison units included deployed and non-deployed veterans In all units chronic
symptom prevalence was significantly greater among deployed than non-deployed
veterans The prevalences of symptoms from five categories: chronic diarrhea,
gastrointestinal complaints, difficult remembering or concentrating, "trouble finding
words", and fatigue, were all reported more often in the deployed Persian Gulf veterans
from the index unit than the deployed veterans from the other units.

Third stage data collection is complete and analysis of the data is underway. (CDC,
1995)

Epidemiological Studies of Morbidity Among Gulf War Veterans: A Search for
Etiologic Agents and Risk Factors - Department of Defense, Naval Health Research
Center

The Naval Health Research Center has undertaken seven epidemiological
investigations of Persian Gulf veterans and their family members Descriptions of each of
these studies can be found in the Appendix B Three studies have produced preliminary
results which were reported at the Annua! Meeting of the American Public Health
Association Meeting in San Diego. CA in October 1995. A brief summary of these studies
and their preliminar\' findings are given below The remaining four studies are in various
stages of progress as reported in the Appendix B

Study 1: A Study of Symptoms among 1500 Seabees

This is a cross-sectional study of morbidity (risk factors and symptoms) of
Seabees (Navy construction workers) who had been on active duty since September 1990
Seabees studied (n=1498) included service members who were deployed to the Persian
Gulf during Operations Desert Shield/Desert Storm, and those who were non-deployed.
All volunteers completed a symptom questionnaire, provided blood and urine specimens,
had height and weight measured, and performed a hand-grip strength test A subset of
volunteers had measurements of pulmonary function made by spirometric techniques.
Preliminary data show that deployed Persian Gulf veterans reported a higher prevalence of
symptoms such as fatigue, headache, muscle or joint pain, and report a higher level of
various exposures When compared to the non-deployed group, the deployed veterans
also had higher scores on several abnormal psychological variables. There were no
observed differences between the two groups in measurements of hand-grip strength and
pulmonan.' fijnction

Study 2: A Comparative Study of Hospitalizations Among Active-Duty Personnel who
Participated in the Gulf War and Similar Personnel who did not

This was a retrospective cohort study in which hospital discharge records from all
DOD hospitals were examined for two groups of service members The first group

103

consisted of nearly all active-duty personnel who deployed to the Persian Gulf between
August 1, 1990 and July 31, 1991 (N=578,492). The second group consisted of a 50%
random sample of personnel (N=699,792) who were on active duty as of September 30,
1990 and were not deployed to the Persian Gulf before July 1991. The hospitalization
rate of deployed service members was lower when compared with non-deployed service
members for the period before the Persian Gulf War. That rate has slowly risen since the
Persian Gulf War approaching the hospitalization rate of the non-deployed veterans. This
time-dependent phenomenon probably reflects a "healthy soldier" effect.

Study 3: A Comparative Study of Pregnancy Outcomes Among Gulf War Veterans
and Other Active-Duty Personnel

The cohorts described in Study 2 were used in this study. Pregnancy outcomes in
the spouses of veterans in these cohorts, and in female Persian Gulf veterans in these
cohorts were examined based upon DOD hospital records. Pregnancy-related outcomes
including spontaneous abortions, stillbirths, and live births were available Pediatric
conditions of livebom children, including birth defects recognized after delivery were also
available. Pregnancy outcomes among spouses of service members were considered
separately from female service members Preliminary results presented at the American
Public Health Association Meeting indicated no overall difference in pregnancy outcomes
or birth defects between the deployed and non-deployed cohorts. Final results are pending
fijrther data analysis which is ongoing

Biomarkers of Susceptibility and Polycyclic Aromatic Hydrocarbon (PAH)
Exposure in L'rine and Blood Cell DNA from U.S. Army Soldiers exposed to Kuwait
Oil Well Fires - National Institutes of Health

In this study urinary metabolites of PAH, PAH-DNA adducts, and genetic
polymorphisms were measured in 62 soldiers in June 1991 prior to deployment to Kuwait,
eight weeks into their deployment, and after their return to Germany from Kuwait in
October 1991 PAH-DNA adduct levels were actually higher in Germany compared to
Kuwait These results are consistent with measurements of surprisingly low ambient PAH
levels in Kuwait in the areas where these soldiers were working despite the presence of oil
well fires nine miles to the north They suggest that these soldiers may not have
experienced significant exposures to PAHs associated with the incomplete combustion of
petroleum while stationed in Kuwait.

Acute Oral Toxicity Study of Pyridostigmine Bromide, Permethrin, and DEET in
the Laboratory Rat - Department of Defense

Pyridostigmine bromide (PB) is a cholinesterase inhibitor (ACHE) that was

supplied to troops for use as prophylaxis against exposure to nerve agents. PB was

distributed to troops in blister packs of 21 tablets of 30 mg each PB tablets were taken

on order when it was believed a gas attack was imminent The recommended dosage was
__ _

104

one tablet every 8 hours PB has t een in use for decades (at much higher dosages) in the
treatment of patients with myasthenia gravis. Short-term side effects are well known ~
eg , nausea, vomiting, diarrhea, abdominal cramps, increased salivation, miosis, headache
and dizziness There have been no documented long-term side effects in humans of this
drug

The simultaneous or sequential administration of neurotropic compounds (for
example, PB and the insect repellent DEET) conceivably could interact to produce an
additive or synergistic effect However, previous research has indicated that PB does not
persist in the body (Breyer-Pfaff et al, 1985) and, therefore, is unlikely to cause any long-
term effects

In 1995 DOD investigators completed a study of the acute interactions of PB,
DEET, and permethrin when administered orally to rats (US Army, 1995, see also
Appendix B) The endpoint studied was lethality at extremely high doses. They found
synergism of effect when PB was combined with DEET and permethrin (another insect
repellent) The relevance of high dose acute oral toxicity studies to the potential for
chronic effects from acute low-level exposures is unknown The lOM panel (lOM, 1995)
concluded that PB is a well-studied medication belonging to a class of drugs about which
ex-tensive knowledge exists and that PB could interact with other compounds to cause
acute and shon-term problems, but was unlikely to cause chronic effects. Nonetheless,
the lOM panel recommended that the possibility of chronic neurotoxic effects needs to be
tested in appropriate animal models (lOM, 1995)

Summary of Current Findings

Findings from some of the early studies just being reported indicate the following:

• Some cohorts of Persian Gulf veterans report an excess of symptoms in
comparison with non-deployed veterans of the same era A connection
between symptoms and a specific disease pathoIog\' or pathologies has not
been identified Until more epidemiological studies are complete, it is not
possible to generalize these resuhs to the entire Persian Gulf veteran
population

• Based on VA and DOD mortality studies to date, there does not appear to be
an excess of disease-specific deaths in Persian Gulf veterans when compared to
veterans of the same era

• The Navy study of hospitalizations indicates that, at least among active duty
personnel, the rate of hospitalizations of Persian Gulf veterans does not exceed
their non-deployed counterparts This suggests that Persian Gulf veterans are
not experiencing an excess of illnesses of a severity that would lead to
hospitalization Caution must be exercised, however, in drawing a more
general conclusion because the study does not account for veterans who may
have left the military, or Reserve/National Guard personnel.

• One focused study of a small cohort of Persian Gulf veterans and one study of
militarv' hospitalizations did not uncover an overall excess of birth defects
among their offspring Although reassuring, caution must be exercised in
drawing more general conclusions about birth outcomes. Several ongoing

105

epidemiologic studies are investigating pregnancy and birth outcomes. Results
from these studies will begin to be available in 1996.

• A DOD study of the interaction of PB, DEET, and permethrin in high dose,
orally-exposed rats provides evidence in an animal model for synergistic effects
of these compounds. This research suggests the need for further exploration of
the potential interactive effects of these compounds at doses of greater
relevance to humans Research currently being conducted by DOD and VA will
attempt to further address issues of PB and other compounds that could have
interacted Aviih it.

Once results from ongoing research becomes available we should have better
knowledge of

• the relationship between symptoms and clinical illness(es);

• risk factors for various illnesses;

• the risk of adverse reproductive outcomes

EXPECTED MILESTONES IN 1996
Research Accomplishments

• Completion of the Health Assessment of Persian Gulf War Veterans
from Iowa

• Completion of Phase I of the National Health Survey of Persian Gulf
Veterans

• Completion of Pennsylvania Air National Guard Study

• Completion of 14 other research projects

Other Milestones

• Publication of final report of the lOM panel on Health Consequences
ofSenice in the Persian Gulf

• Publication of final report of the Presidential Advisory Committee on
Gulf War Veterans ' Illnesses

• A Working Plan for Research on Persian Gulf Veterans ' Illnesses -
Revised

40-180 97 - 5

106

REFERENCES

Beach P, Blanck RR, Gerrity T. Hyams KC, Mather S, Mazzuchi JF, Murphy F, Roswell
R, Sphar RL Coordinating federal efforts on Persian Gulf War veterans Fed Prac 12:9-

16, 1995

Breyer-Pfaff U, Maier U, Brinkman ANM, Schumm F Pyridostigmine kinetics in healthy
subjects and patients with myasthenia gravis Clin Pharmacol Ther. 37:495-501, 1985.

Centers for Disease Control (CDC) Morbidity and Monality Weekly Report: Unexplained
Illness Among Persian Gulf War Veterans in an Air National Guard Unit: Preliminary
Report Aug 1990 - Mar 1995 44(23):443-447, 1995.

Defense Science Board (DSB) Final Report Defense Science Board Task Force on
Persian Gulf War Health Effects Washington, DC: Office of the Under Secretary of
Defense Acquisition and Technology

Institute of Medicine (lOM) Health Consequences of Service During the Persian Gulf
War Initial Findings and Recommendations for Immediate Action. Committee to Review
the Health Consequences of Service During the Persian Gulf War Medical Follow-Up
Agency, Institue of Medicine National .Academy Press, Washington, DC. 1995.

Kang HK, Bullman T.A. Monality Follow-up Study of Persian Gulf Veterans. Presented at
the Annual Meeting of the American Public Health Association Meeting, October 31,
1995 (See Appendix D)

National Institutes of Health (NIH) Technology Assessment Workshop Panel: The Persian
Gulf experience and health JAMA 272(5)391-396, 1994

Penman A, Tarver R, Currier M No evidence of increase in birth defects and health
problems among children bom to Persian Gulf war Veterans in Mississippi Military
Medicine 161 1-6 1996

The Persian Gulf Veterans Coordinating Board Action Plan April 25, 1996.

US Army Center for Health Promotion and Preventive Medicine Report. Acute Oral
Toxicity Study of Pyridostigmine Bromide, Permethrin, and DEET in the Laboratory Rat
Toxicoiogical Study 75-48-2665, May 31, 1995

Writer J\', DeFraites RF, Brundage JF Comparative mortality among US military
Personnel in the Persian Gulf region and worldwide during Operations Desert Shield and
Desert Storm JAMA 275:1 18-121, 1996

107
VA PROGRAMS FOR PERSIAN GULF VETERANS

Januar> 1996

The Department of Veterans Affairs fVA) offers Persian Gulf veterans special examinations and priority follow-on
care, and it operates a toll-free hotline at 800-749-8387 to inform these veterans of the program and their benefits.
VA also IS compensating veterans under unprecedented regulations addressing undiagnosed conditions. Special
research centers and additional medical investigations are searching for answers to aid seriously ill patients whose
underlying disease is unexplained. Most Gulf veterans are diagnosed and treated; but for some, such symptoms as
joint pain or fatigue have been chronic. Some have responded to treatment of symptoms even though their doctors
have not yet identified an imderlying illness or pathogenic agent.

UNEXPLAINED ILLNESS:

The prevalence of unexplained illnesses among Persian Gulf veterans is uncertain. Data from special VA
examinations show that 8,980 veterans had current symptoms and did not receive a diagnosis. This may be an
overestimate or underestimate of the problem of "undiagnosed illnesses" as the diagnoses recorded may not explain
all the symptoms. Further, VA does not have information on the chronology, severity or current existence of the
symptoms. Answers about illness prevalence are expected through research involving representative samples of the
Gulf veteran population (see page 3).

PERSL\N GULF "SYNDROME" UNDEFINED:

Several panels of government physicians and private-sector scientific experts have been unable to discern any new
illness or unique symptom complex such as that popularly called "Persian Gulf Syndrome." "No single disease or
syndrome is apparent, but rather multiple illnesses with overlapping symptoms and causes," wrote an outside panel
led by professors from Harvard and Johns Hopkins University that convened for an April 1994 National Institutes
of Health (NIH) workshop. VA has neither confirmed nor ruled out the possibilirv' of a singular Gulf syndrome.

RESEARCH AND RISK FACTORS:

With variation in exposures and veterans' concerns ranging from depleted uranium in armaments to possible
contamination from Iraqi chemical/biological agents. VA has initiated wide-ranging research projects evaluating
illnesses as well as risk factors in the Gulf environment, spending $2.75 million in fiscal year 1995. The activation
of three research centers conducting 14 protocols has enabled VA to broaden its activity from largely descriptive
evaluations to greater emphasis on hypothesis-driven research.

Statistics

Some 945,000 servicemembers served in the Gulf from August 1990 through the end of 1994, nearly 697,000 of
them serving in the first year, .^bout 505,600 have become potentially eligible for VA care as veterans, having
either left the militarv- or having become deactivated reservists or Guard members. More than 54,000 veterans have
responded to VA's outreach encouraging any Gulf veteran to gel a free physical exam under V.'^'s Persian Gulf
Program. Not all are ill:

13 percent of the veterans who had the registry health exam had no health complaint (among the first 44.190
computerized records).

108

25.5 percent ot ihc same group rated their health as poor or ver> poor, while 73 percent reported their health as all
right to ver\ good (the remaining 1.5 percent did not have an opinion).

SPECIAL HEALTH EXAMINATION:

A free, complete physical examination with basic lab studies is offered to ever\ Persian Gulf veteran, whether or
not the veteran is ill. A centralized registr> of participants, begun in August 1992. is maintained to enable VA to
update veterans on research findings or new compensation policies through periodic newsletters. This clinical
database also provides information about possible health trends and may suggest areas to be explored in future
scientific research. The 54.000 Persian Gulf veterans who have taken advantage of the physical examination
program become part of a larger Persian Gulf Registry. As defined by P. L. 102-585. this includes 181.000 Gulf
veterans (generallv including those counted in the special examination program) who have been seen for routine
VA hospital or clinic care, or who have filed compensation claims -- or whose survivor registers a claim.

PERSIAN GULF INFORMATION CENTER:

VA offers a toll-free information line at 800-PGW-VETS (800-749-8387) where operators are trained to help
veterans with general questions about medical care and other benefits. It also provides recorded messages that
enable callers to obtain information 24 hours a day. Information also is being disseminated 24 hours a day through a
national computer bulletin board, VA-ONLINE, at 800-USl-VETS (800-871-8387). It also can be reached at
telnet://vaonline.va.gov via the Internet.

PRIORITY ACCESS TO FOLLOW-ON CARE:

VA has designated a physician at every VA medical center to coordinate the special examination program and to
receive updated educational materials and information as experience is gained nationally. Where an illness possibly
related to exposure to an environmental hazard or toxic substance is detected during the examination, followup care
is provided on a priority basis. As with the health examination registry. VA requested and received special statutory
authority to bypass eligibility rules governing access to the VA health system.

PERSIAN GULF REFERRAL CENTERS:

If the veteran's illness defies diagnosis, the veteran may be referred to one of four Persian Gulf Referral Centers.
Created in 1992. the first centers were located at VA medical centers in Washington, DC; Houston: and Los
.\ngeles, with an additional center designated at Birmingham. Ala., in June 1995. These centers provide assessment
by specialists in such areas as pulmonary and infectious disease, immunology, neuropsychology, and additional
expertise as indicated in such areas as toxicology or multiple chemical sensitivity. There have been approximately
287 veterans assessed at the centers; most ultimately are being diagnosed with known/definable conditions.

STANDARDIZED EXAM PROTOCOLS:

VA has expanded its special examination protocol as more experience has been gained about the health of Gulf
veterans. The protocol elicits information about symptoms and exposures, calls the clinician's attention to diseases
endemic to the Gulf region, and directs baseline laboratory studies including chest X-ray (if one has not been done
recently), blood count, urinalysis, and a set of blood chemistry and enzyme analyses that detect the "biochemical
fingerprints" of certain diseases. In addition to this core laboratory work for every veteran undergoing the Persian
Gulf program exam, physicians order additional tests and specialty consults as they would normally in following a
diagnostic trail — as symptoms dictate. If a diagnosis is not apparent, facilities follow the "comprehensive clinical
evaluation protocol" originally developed for VA's referral centers and now used in VA and military medical
centers nationwide. The protocol suggests 22 additional baseline tests and additional specialty consultations.

109

outlining dozens of further diagnostic procedures to be considered, depending on symptoms.

Veterans have reported a wide range of factors observed in the Gulf environment or speculative risks about which
they have voiced concerns. Some are the subject of research investigations and none have been ruled out. There
appears to be no unifying exposure that would account for all unexplained illnesses. Individual veterans' exposures
and experiences range from ships to desert encampments, and differences in military occupational specialty
frequently dictate the kinds of elements to which servicemembers are exposed.

Veteran concerns include exposure to the rubble and dust from exploded shells made from depleted uranium (or
handling of the shells); the possibility of a yet-unconfirmed Iraqi chemical-biological agent; and a nerve agent
pre-treatment drug, pyridostigmine bromide. Many other risk factors also have been raised. In 1991 , VA initially
began to develop tracking mechanisms that matured into the Persian Gulf Registry as a direct consequence of early
concerns about the environmental influence of oil well fires and their smoke and particulate. InteragencN'
Coordination and White House Response

The federal response to the health consequences of Persian Gulf service is being led by the Persian Gulf Veterans
Coordinating Board composed of the Departments of VA, Defense and Health and Human Services. Working
groups are collaborating in the areas of research, clinical issues and disability compensation. The Board and its
subgroups are a valuable vehicle for communication between top managers and scientists, including a staff office
for the Board that follows up on critical issues and promotes continuity in agency activities. President Clinton
designated VA as the Coordinating Board's lead agency.

In March 1995, President Clinton announced formation of a Presidential Advisory Committee on Gulf War
veterans' illnesses to review and make recommendations on: Coordinating Board activities; research, medical
examination and treatment programs; federal outreach; and other issues ranging from risk factors to chemical
exposure reports. It has been meeting since August 1995 and currently is developing an interim report. Medical
Research

Environmental Hazards Research Centers:

Through a vigorous scientific competition, VA developed major focal points for Gulf veteran health studies at three
medical centers: Boston; East Orange, N.J.; and Portland. Ore. With 14 protocols among them, the centers are
conducting a variety of interdisciplinary projects, including some aimed at developing a case definition for an
unexplained illness and clarification of risk factors. Some protocols involve areas of emerging scientific
understanding, such as chronic fatigue syndrome or multiple chemical sensitivity, while others are evaluating or
comparing factors in immunity, psychiatry, pulmonary response, neuroendocrinology and other body systems, some
at the molecular level.

Health Survey and Mortality Study.

VA's Environmental Epidemiology Service is surveying 15,000 randomly selected Gulf veterans and an equal size
control group of veterans of the same time period (but who were not deployed) to compare symptoms in veterans
and their family members, examining risk factors and providing physical examinations for a representative sample
to help validate the self-reported health data. That office also is engaged in a mortality study, analyzing death
certificates to determine any patterns of difference in causes of deaths between deceased Gulf veterans and matched
controls. Preliminary data have suggested the deployed veterans have a higher rate of post-war deaths due to
accidents and traumatic injury as opposed to diseases or illness. Further analysis is continuing, with a report
expected to be submitted for publication in a scientific journal later this year. (Independent of the study, VA has
learned of 2,900 deaths among deployed veterans, which is lower than expected under general U.S. mortality rates.)

Exposure-Oriented Studies:

110

Some current VA investigations are examining hypotheses of specific potential rislcs and comparing study subjects
with controls who did not ser\'c in the Gulf to determine differences in heahh patterns. A Uaitimore project is
following the health status of individuals who retained tiny embedded fragments of depleted uranium.

A Birmingham, Ala., pilot program ofTers an extensive battery of neurological tests aimed at detecting dysfunction
that would be expected after exposure to certain chemical weapons.

Other Federal and Collaborative Studies:

In its second annual report to Congress in March 1995, VA, on behalf of the Persian (iulf Veterans Coordinating
Board participating agencies, detailed about 50 Persian Gulf research initiatives, reviews and clinical investigations,
many involving VA. For example, VA investigators are collaborating with the Naval Medical Research Center in
San Diego in general epidemiological studies comparing Gulf veterans and control-group veterans (who served
elsewhere) to detect differences in symptoms, hospitalizations, and birth outcomes in large cohorts of active duty
servicemembers. A detailed research working plan is available online at http://www.dtic.dla.mil/gulflinkyvarpt via
Internet.

Outside Reviews:

With the Department of Defense (DOD), VA has contracted with the National Academy of Sciences (NAS) to
review existing scientific and other information on the health consequences of Gulf operations. Congress has
authorized VA and DOD to provide up to $500,000 annually to fund the review. In its first report issued in January
1995, a committee of the NAS Institute of Medicine called for systematic scientific research, including large
epidemiological studies. Its recommendations urged greater coordination between federal agencies to prevent
unnecessary duplication and assure high-priority studies are conducted. It made a number of recommendations for
improvements to programs for Gulf veterans.

Another nongovernment expert panel brought together at an NIH technology assessment workshop in April 1994
examined data and heard from both veterans and scientists, concluding that no single or multiple etiology or
biological explanation for the reported symptoms could be identified and indicating it is impossible at this time to
establish a single case definition for the health problems of Gulf veterans. A copy is available through
VA-ONLINE.

VA also has a standing scientific panel that includes both agency and nongovernment experts to evaluate its
activities and provide advice in open meetings. VA Disability Compensation

On Feb. 3, 1995, VA published a final regulation on compensation payments to chronically disabled Persian Gulf
veterans with undiagnosed illnesses. The undiagnosed illnesses, which must have become manifest either during
service in or within two years of leaving the Southwest Asia theater, may fall into 1 3 categories: fatigue; signs or
symptoms involving skin; headache; muscle pain; joint pain; neurologic signs or symptoms; neuropsychological
signs or symptoms; signs or symptoms involving the respiratory system (upper or lower); sleep disturbances;
gastrointestinal signs or symptoms; cardiovascular signs or symptoms; abnormal weight loss; and menstrual
disorders. While these categories represent the signs and symptoms frequently noted in VA's experience to date,
other signs and symptoms also could qualify for compensation. A disability is considered chronic if it has existed
for at least six months. For claims considered under this special regulation, VA has a 29 percent approval rate
among claims where the veteran has demonstrated symptoms within the two-year period allowed by law. Among
the remaining 71 percent, most are diagnosable conditions treated under conventional regulations, while some
symptoms fail to meet the 6-month chronicity requirement or are found to be related to another known cause.

Outside of the new regulation. VA has long based monthly compensation for veterans on finding evidence a

Ill

condition arose during or was aggravated by service. VA has approved 22.387 compensation claims ot Gulf
veterans for service injuries or illnesses of all kinds, including 976 claims in which the veteran alleged the cause
was an environmental hazard, and within that group, 386 claims approved under the new undiagnosed illnesses
regulation.

112

STATEMENT BY SENATOR STROM THURMOND (R-SC) BEFORE A JOINT HEARING
BY THE SENATE VETERANS AFFAIRS COMMITTEE AND INTELLIGENCE
COMMITTEE REGARDING MILITARY EXPOSURE TO CHEMICAL NERVE AGENTS IN
IRAQ; WEDNESDAY, SEPTEMBER 25, 1996; HART 216, 10:30 A.M.

MR. CHAIRMAN:

The exposure of our Armed Forces personnel to chemical nerve
agents is a matter of great concern. The well-being of those who
served in the Persian Gulf, is an issue that I have vigorously pursued.
As chairman of the Armed Services Committee, I have included
provisions in Defense authorization bills establishing the Persian Gulf
War registry, providing funding for research, and directing a study on
low-level exposure to nerve agents. Of course, under the lead of
Senator Shelby, the Committee did a study in various nations in the
Coalition regarding possible exposure.

In 1994, the Department of Defense sent a summary to Congress
to report the findings of the Defense Science Board's review of Iraq's
chemical/Biological Warfare use during the Persian Gulf War. That
summary reported that the task force found no evidence of overt,
intentional use of biological or chemical weapons by the Iraqis.
Furthermore, their investigation found no credible source of low levels
of exposure to chemical weapons, making such exposure unlikely.

113

Mr. Chairman, we now know that our troops were exposed to
nerve agent released as a result of postwar demolition of chemical
rockets at an ammunition storage area in Iraq. The Pentagon
acknowledged it has known since November 1991 that nerve weapons
were stored in Iraq, but claims it had not realized U.S. troops were
involved in the March 1991 depot destruction.

In light of these developments, it is critical that the government
continue to identify those who may have been exposed to nerve agents
to assess their health, and to continue to provide medical care.

Mr. Chairman, as we discuss these concerns, let us keep in mind
that we are dealing with more than words or reports. What is at issue
is the treatment of human beings - men and women who served their
country. This Committee has previously heard the testimony of
numerous Veterans who went to the Gulf in excellent health and
returned with various illnesses and disabilities. Included in the list of
complaints are swellings, headaches, rashes, pain in the joints, chronic
fatigue, neurological disorders, respiratory troubles and flu like
symptoms.

I believe both the Department of Veterans Affairs and the
Department of Defense are concerned for the well-being of those who

114

served in the Persian Gulf. The Department of Veterans Affairs has
taken action to address the many mysteries surrounding the various
ailments, commonly described as "Persian Gulf Syndrome." Such
actions include the establishment of the Persian Gulf Registry to
provide health exams and health monitoring of Veterans, as well as the
institution of various research programs to identify the causes of the
unexplained illnesses reported by Persian Gulf Veterans.

I thank the chairman of both committees for holding this
important hearing today. I look forward to reviewing the testimony of
the witnesses and working with you to make sure our veterans are
treated fairly and honorably.

115

Opening Statement

Senator Alan K. Simpson

Senate Committee on Veterans' Affairs and Senate Select Committee
on Intelligence Joint Hearing

Chemical Weapons in the Gulf

September 25, 1996

I am pleased to be present today for this hearing to address the
recent Pentagon reports that U.S. military personnel may have been
exposed to low-levels of chemical nerve agent in March 1991 during
post-Persian Gulf War bunker destructions in Iraq. I have been most
eager to work with my friend, Senator Arlen Specter, the Chairman of the
Senate Select Committee on Intelligence, in crafting this hearing. I know
that his concerns for any military personnel who may have been exposed
to nerve agents are most sincere. I share that deep concern as does
everyone in this Congress and the last 103rd Congress.

It is clear that we need to know more about the Khamisiyah bunker
in Southern Iraq that was destroyed back in March 1991. I have read
the August 2, 1996 CIA report on the matter as well as statements that
have been issued by the DOD. Questions still remain. We need more
information and it is my intent to gather it today in the most productive

116

way possible. Today's proceeding is not in any way an attempt to round-
up "The Accused." It is a good faith effort to ground ourselves in the
facts so that we might be able to perform our jobs in a thoughtful
manner.

It is my hope that by hearings' end, we will have a better
understanding, for example, of why the UNSCOM report that was
transmitted to the DOD in November 1991 was not given more
consideration? Was it because of the "fog of war?" We are soon to find
out. Why did chemical detectors not go off when the Khamisiyah bunker
was destroyed by the U.S. Army? Importantly, what was learned from
this experience? If errors were made, what can be done to ensure it
does not happen again? These are but a few of the questions swirling
about. Indeed, I welcome the expert testimony of the VA, DOD and CIA.
It will be helpful to hear from each of these fine and seasoned witnesses.

I am well aware of the veterans who believe it is the low-level nen/e
agent exposures from the Khamisiyah bunker destrjjction that made them
ill. Many of them contact me. They speak from their hearts. I hear

117

them. Nobody wants veterans who have served our nation with pride
and distinction to be suffering. Nobody. Nobody doubts that many of
them are ill. But we don't know exactly what is making them sick.
Researchers have not been able to conclude that the symptoms are the
result of any one unique illness. That is why a great research, outreach,
treatment and compensation effort was set in motion during the 103rd
Congress. We are continuing with this aggressive response under my
watch as Chairman of the Senate Veterans Affairs Committee -- and the
effort will continue long after I retire from the Senate.

I do want everyone to know of the federal government's vast
involvement with our Persian Gulf veterans. Indeed, the VA will speak to
that in a few minutes but I do want to enter into the record two
documents that list all that we are doing for our sick Persian Gulf
veterans. We are a great nation and we have allocated great resources
for our sick veterans.

The VA has over 30 research projects underway. It has three
Environmental Hazards Research Centers and has announced the
creation of a fourth center. The VA is also, undertaking a gargantuan

118

epidemiological survey and study. It will compare a representative
sampling of 15,000 deployed Persian Gulf veterans with a control group
of 15,000 veterans who served stateside or in other locations away from
Southwest Asia dunng the Persian Gulf War. Results are due in 1998.

Congress also passed legislation requiring that sick Persian Gulf
veterans be compensated by the VA -- EVEN IF THERE IS NO
DIAGNOSIS OF DISEASE. There are 13 categories of undiagnosed
illnesses for which a Persian Gulf veteran can be compensated.
Congress also mandated that Persian Gulf veterans receive priohty
treatment at VA hospitals.

This is just a smattering of the many ongoing federal activities for
the Persian Gulf veterans. The other agencies included in the
multiagency research effort are the Department of Defense, the National
Institutes of Health, the Centers for Disease Control, the National
Academy of Science, the Environmental Protection Agency and more.

I will simply say that this Congress, and the 103rd Congress,
accomplished a great deal for our nation's Persian Gulf veterans.

119

Coordinated efforts are underway to treat them, to compensate them and
to better understand their ailments. They have been uppermost in our
minds and for anyone to say otherwise is plain wrong.

Thank you. I do look fonA/ard to today's hearing.

120

vice Chairman Kerrey

Senate Select Committee on Intelligence

Opening Statement

Hearing on the Investigation of Gulf War Syndrome

September 25, 1996

Mister Chairman, the Persian Gulf War ended over five
years ago. Our gratitude and concern for the brave men
and women who fought in that conflict continues. Our
nation and the rest of the world owe a great debt to the
soldiers who fought to liberate Kuwait. Paying the debt
means we should not let America's victory translate into
personal tragedy for the soldiers who suffer from unique,
unexplained sicknesses caused by their service in Kuwait.

We meet today as part of an ongoing effort to identify and
understand the ailments which mysteriously afflict many of
our veterans. The fact our government continues this
effort so long after the war ended reflects the United
States' commitment to finding a diagnosis and a cure.

Our specific concern on the Intelligence Committee is to
be sure all appropriate collection and analytical
resources have been focused on this problem. Our
intelligence collectors and analysts must find and sift
all the data available about the chemical and biological
environment of the Kuwait battlefield. When new evidence
sheds additional light on old reporting, enabling our
analysts to piece together more of this puzzle, we should
not criticize people who decided not to act on incomplete
information. We need to encourage them to continue their
work and uncover even more information.

While some may seek to find fault, I see many departments
and agencies and thousands of people within the military.

121

the intelligence community, and medical community working
diligently trying to find both the cause and the cure for
this problem. I hope their persistent efforts will
continue unimpeded and their work will soon pay off.

We will also today be hearing about chemicals such as
mustard gas, sarin, and cyclo- sarin. We were fortunate
during the Gulf War that these compounds were not used as
weapons against our men and women. These horrible weapons
should never again be used. Their presence in the Gulf
theater in the hands of Saddam Hussein is a strong
argument for the United States to continue to lead the
international community in the effort to outlaw these
weapons of mass destruction by all means, including
ratification of the Chemical Weapons Convention as soon as
possible.

122

( I'nirjl lnli'llis:cni.c Xj.-

i.liini:ion, 1) (.■ ;i'-ii

13 February 199'

The Honorable Arlen Specter

Chairman

Committee on Veterans' Affairs

United States Senate

Washington, D.C. 20510

Dear Mr. Chairman:

Enclosed are answers to questions Mr. John McLaughlin

received from former Committee Chairman Alan Simpson subsequent

to the joint SSCI/Veterans Affairs Gulf War Illnesses hearing on

25 September 1996. If you require any further assistance, please

do not hesitate to call.

Sincerely,

Johii H . Mos^man
Director of /Congressional Affairs

Enclosure

123

The Honorable Arlen Specter

Question # 1 . What were the differences between the United
Nations' reports of November 1991 and May 1996 regarding the
evidence of chemical rounds at Bunker 73?

A. Iraqi chemical rockets are externally identical to
conventional rockets. Prior to the May 1996 inspection, UN
reporting implied that the UN believed or assumed the presence of
chemicals in Bunker 73, but no sampling was done, and chemical
agent monitors did not detect nerve agents. The UN reports of
November 1991 relating to Bunker 73 addressed the munitions there
but did not record or document - - either in written,
photographic, or video form - - information to show if the rounds
at Bunker 73 had been chemical. The May 1996 inspection
documented interior design features - - such as plastic inserts
and burster tubes - - that removed any uncertainty that the
rockets in Bunker 73 were chemical rockets.

Question #2. In light of this recent reexeunination of the
DNSCOM Report, are documents detailing the numerous false
chemical alarms being reexamined as well? If so, by whom?

A. DoD has an ongoing effort to reexamine the circumstances
that caused the alarms to go off.

Question #3. Why, in your view, did the DoD determine
that there was no relationship between the UNSCOM document
and the operations of the 37th Engineering Battalion?

A. We can not speak for the Department of Defense and believe
that the question should be directed to appropriate DoD
officials .

124

THE ASSISTANT SECRETARY OF DEFENSE
WASHINGTON, D C 20301-1200

1 0 m

Honorable Arlen Specter

Chairman. Committee on Veterans" Affairs

United States Senate

Washington DC 20510

Dear Mr. Chairman:

This is in response to Senator Simpson's letter, w-ritten as Chairman of the
Committee on Veterans' Affairs, concerning some additional questions subsequent to Dr.
Joseph's testimony before the Comminee on September 25. 1996. I have enclosed the
information you requested, with respect to: the kind of research DoD has carried out on
the effects of low-level nerve agent exposure to date (Enclosure 1); when the GIS will be
completed and available for use by researchers (Enclosure 2); and whether anylhing has
been published concerning the personal communications with Dr. Fred Sidell cited in the
Report on Possible Effects of OP Low-Level Nerve Agent Exposure (Enclosure 3).

I have just recently received the responses requested from the various agencies
involved. I regret the delay in our response.

Sincerely,

Stephen C. Joseph, M.D., M.P.H.

Enclosures:
As Stated

Honorable John D. Rockefeller, IV
Ranking Democrat

125

Senate Committee on Veterans' Affairs
September 25, 1996

Question 1: What kind of research has the DoD carried out on the effects
of low-level nerve agent exposure to date? Please explain the kinds of low-level
exposure research the DoD will undertake with the S3. 5 million recently
committed to this research?

Answer: A list of references is included, detailing some of the studies conducted
by DoD that are relevant to the clinical effect of nerve agents. Also, in combination with
the Departments of Veterans Affairs and Health & Human Services, DoD has
implemented an aggressive research program to better understand the symptoms and
illnesses experienced by Persian Gulf veterans. Enclosed is a copy of "A Working Plan
For Research on Persian Gulf Veterans" Illnesses," dated November 1996, prepaied by
the Research Working Group of the Persian Gulf Veterans" Coordinating Board. This
document contains information concerning the whole research program surrounding
Persian Gulf illnesses, including research concerning possible low-level chemical
weapons exposure. In FY96, as a result of new information concerning the destruction of
Iraqi chemical weapons immediately following the Persian Gulf War, DoD and VA
committed $5 million to study the health effects of possible subclinical exposure to
chemical warfare agents. Of the $5M, S2.5M was allocated immediately to fund three
research proposals. The remainder was allocated to fund scientific proposals to determine
the feasibility of epidemiological studies, in human subjects, including those thought to
be near Khamisiyah, Iraq, during the first two weeks of March, 1991, and to conduct
animal studies, designed to assess the possible long-term or delayed clinical effects of
low-level or subclinical exposure to chemical warfare agents. The dead line for these
proposals was February 19, 1997. We expect to fund the best proposals, based on
scientific merit and military relevance by September 30, 1997. An additional $9.5
million of FY97 fimds have been allocated to investigate the causal relationships between
illnesses and symptoms among Gulf War veterans and possible exposures to hazardous
material; chemical warfare agents; stress; potentially hazardous combinations of
inoculations and investigational new drugs during military service in the Southwest Asia
theater of operations during the Persian Gulf War. The deadline for proposals is March
II, 1997.

Enclosures:
As Stated

126

us ARMY MEDICAL RESEARCH INSTITUTE OF CHEMICAL DEFENSE (USAMRICD)

This list of references of published results are from studies conducted by the DoD which are
relevant to the clinical effects of acute or chronic exposure to ner%'e agents This list is only a
small subset of published results of studies supported by the DoD on the effects of nerve agents,
their mechanisms of action, and their response to medical countermeasures.

DOSE-RELATED ACUTE AND CHRONIC EFFECTS OF
EXPOSURE TO ORGANOPHOSPHORUS CHEMICAL AGENTS

REFERENCES

Albuquerque EX Molecular targets of organophosphorus compounds and antidotal agents on
nicotinic, glutamatergic and gabraergic synapses. (1994) Baltimore, MD University of
Maryland Final Report, Appendix II, Vol 2.

Bates HK et al. Developmental toxicity of soman in rats and rabbits ( 1 990) Teratol. _42: 1 5-23

Bates HK et al. Developmental toxicity evaluation of soman in CD rats ( 1 987) Toxicol. T. 1 74.

Baze WB. Soman-induced morphologic changes: an overview in the nonhuman primate (1993)
MpplToxicol 13 : 1 73- 1 77

Bertino JR, Geiger LE, Sim VM CWLR2156 Accidental V agent exposures (6 August 1957)
Unclassified Report Edgewood Maryland: CRDLC, Department of Defense

Bowers MB, Goodman E, Sim VM Some behavioral changes in man following
anticholinesterase administration (1964) JNervMentDis. 1 3 8 : 3 8 3 ff.

Brody BB DPG MIB Scientific Report No 5 Seventy-five cases of accidental nerve agent
poisoning at Dugway Proving Ground ( 1 0 December 1 954) Unclassified Report Salt
Lake City: Dugway Proving Ground, Department of Defense

Brown EC MDR 158 Effects of G agents on man: clinical observations (19 October 1948)
Unclassified Report. Edgewood Maryland: USAMRICD, Department of Defense

Bucci TJ et al. Toxicity studies on agents GB and GD (Phase II): delayed neuropathy study of
.sarin, type I, in white leghorn chickens. (1992) Jefferson, AR: National Center for
Toxicological Research Final Report AD-A257357

Bucci TJ et al. Toxicity studies on agents GB and GD (Phase II): delayed neuropathy study of
sarin, type II. in SPF white leghorn chickens. (1992) Jefferson, AR: National Center for
Toxicological Research Final Report AD-A257183.

Bucci TJ et ai Toxicity studies on agents GB and GD (Phase II): delayed neuropathy study of
GD (soman), in white leghorn chickens. (1992) Jefferson, AR; National Center for
Toxicological Research Final Report AD-A258664

Bucci TJ et al. Toxicity studies on agents GB and GD (Phase II): 90-day aubchronic study of
GB I (sarin, type I) in CD rats (1992) Jefferson, AR: National Ceriter for Toxicological
Research Final Report AD-A248617

127

Bucci TJ el al. Toxicity studies on agents GB and GD (Phase II): 90-day subchronic study of
GB II (sarin, type II) in CD rats. ( 1 992) Jefferson, AR National Center for Toxicological
Research Finai Report AD-A248618

Bucci TJ el al. Toxicity studies on agents GB and GD (Phase II): 90-day subchronic study of
GD (soman) m CD rats. (1992) Jefferson, AR National Center for Toxicological Research
Final Report AD-A258180

Bucci TJ el al. Toxicity studies on agent GA (Phase II): 90-day subchronic study ofGA (tabun)
in CD rats. (1992) Jefferson, AR National Center for Toxicological Research Final
Report AD-A300161 AD-A257181.

Bucci TJ et al. Developmental toxicity study (Segment II teratology) of tabun m CD rats and in
New Zealand White rabbits. (1993) Jefferson, AR National Center for Toxicological
Research Final Report AD- A300 161.

Bucci TJ, Parker RM, Gosnell, PA Toxicity studies on agents GB and GD (phase II): Delayed
neuropathy study of sarin, type I. in SPF white leghorn chickens. ( 1 992) Jefferson, AK:
National Center for Toxicological Research.

Bucci TJ, Parker RM, Gosnell PA Delayed neuropathy study of .sarin, type II. in SPF white
leghorn chickens. ( 1 992) Jefferson, AR: National Center for Toxicological Research.

Bucci TJ, Parker RM, Gosnell PA Toxicity Studies on Agents GB and GD. ( 1 992) Jefferson,
AR: National Center for Toxicological Research

Burchfiel JL, Duffy FH, Sin VN Persistent effect of sarin and dieldrin upon the primate
electroencephalogram (1976) ToxicolApplPharmacol. 35:365-379.

Carlon HR Compendium of hazard definition data for chemical agents GA, GB, GD, GF, HD,
HT, and VX, including a selected bibliography AD-B 126270.

Castro CA e/ al. Behavioral decrements persist in rhesus monkeys trained on a serial probe
recognition task despite protection against soman lethality by butyrylcholinesterase ( 1 994)
NeurotoxdTerat. \6:\45-\4S

Craig AB, Comblath M. MLRR 234 Further clinical observations on workers accidentally
exposed to G agents (December 1953) Unclassified Report, Edgewood, Maryland:
USAMRICD, Department of Defense

Craig AB, Freeman G MLRR 1 54 Clinical observations on workers accidentally exposed to G
agents (January 1953) Unclassified Report, Edgewood, Maryland: USAMRICD,
Department of Defense.

Crowell JA et al. Neuropathy target esterase (NTE) in chickens after treatment with
isopropylmethylphosphonofluoridate (sarin - type I and II). (1988) Toxicol. 8:50.

Crowell J A, Parker RM, Bucci, TJ, Dacre JC Neuropathy target esterase in hens after sarin and
soman (1989) JBiochemToxicoL 4:15-20.

Dacre JC Toxicological smdies on chemical agents GA, GB, GD, VX, HD and L (1989) In:
Proceedings of Third International Symposium on Protection Against Chemical Warfare
Agents, p 179

128

DacreJL Delayed neuropathy studies on agents G A, GB, BD, and VX (1989) In:
PriKeedrngs of the 1989 Medical Bioscience Review Conference, pp 234-240

Dacre JL Toxicology of some anticholinesterases used in chemical warfare agents A review

(1984) In Cholmesierases - lundamenial and Applied Aspects, pp 415-426

deJong RH Drug therapy of nerve agent poisoning (research efforts and medical objectives)

(1985) Aberdeen Proving Ground, MD: TR85-01 U.S. Army Medical Research Institute of
Chemical Defense.

Duffy FH, Burchfiel JL Long-term effects of the organophosphate sarin on EEGs in monkeys
and humans (1980) Neurolox. 1667 -6%9

Dulaney MD jr, Hoskins B, Ho IK Studies on low sub-acute administration of soman, sarin and
tabun in the rat. (1985) AciaPharmacol.elToxicol 57:234-241

Freeman G, Marzulli FN, Craig AB el al. MLRR 217 The toxicity of liquid GB applied to the
skin of man. (September 1953) Unclassified Report Edgewood, Maryland USAMRICD,
Department of Defense

Gammill JF DPG MIB Scientific Report No 1 Report of mild exposure to GB in 21 persons
(19 March 1954) Unclassified Report Salt Lake City Dugway Proving Ground,
Department of Defense

Gaon MD, Weme J A study of human exposures to GB (December 1955) Unclassified Report.
Rocky Mountain Arsenal, Denver, Colorado, Department of Defense

Geller I The effects of cholinesterase inhibition on operant behavior of laboratory rats and
juvenile baboons. Possible protection against and reversal of the effects with cholinergic
agents. ( 1 984) San Antonio, TX: Southwest Foundation for Research and Education.

AD-A149754.

Geller I, Saws A, Staninoha WB Effects of subchronic soman on avoidance escape behavior and
cholinesterase activity (1987) Neurotox. /'era/o/. 9:377-386.

Goldman M et al Toxicity studies on agents GB and GD. Davis, C A: University of California
Davis Laboratory for Energy-Related Health Research Final Report AD- Al 8784 1

Grob D, Harvey JC Effects in man of the anticholinesterase compound sarin (isopropyl methyl
phosphonofluoridate). (1958) yC/w/m-ei/. 37:350-368.

Grob D, Harvey JC, Harvey AM MDRR 18 Observations on the effects in man of methyl
isopropyl fluorophosphonate (GB) (August 1950) Unclassified Report Edgewood,
Maryland: USAMRICD, Department of Defense

Grob D, Ziegler B, Saltzer CA et al. (1953) Further observations on the effects in man of methyl
isopropyl fluorophosphonate (GB): effects of percutaneous absorption through intact and
abraded skin. (January 1953) DA 18-108-CML-3014. Johns Hopkins University and
Hospital Unclassified Report Edgewood, Maryalnd: USAMRICD, Department of
Defense.

Haggerty GC, Kurtz PJ, Armstrong RD Duration and intensity of behavioural changes after
sublethal exposure to soman in rats (1986) Neurobehav Toxicol. 8:695-702

129

Harvey JC MLRR 1 14 Clinical observations on volunteers exposed to concentrations of GB
(May 1952) Unclassified Report Edgewood, Maryland: US AMRICD, Department of
Defense

Hayward IJ et al. Effects of repeated intramuscular low doses of soman in rhesus monkeys.

(1990) Aberdeen Proving Ground, MD TR88-12 US Army Medical Research Institute of
Chemical Defense A225002

Henderson JD, Higgins RJ, Rosenblatt L, Wilson BW Toxicity studies on agent GA. Delayed
neurotoxicity— acute and repeated exposures of GA (tabun). (1989) Davis, C A: Univ.
California Davis Lab for Energy.

Johns RJ TTie Effects of Low Concentrations ofGB on the Human Eye [Medical Laboratory
Research Report I OOJ (1952) Edgewood Arsenal, MD Medical Research Laboratory

Kant GJ et al. Effects of soman on neuroendocrine and immune function ( 1 99 1 )
Neurotox&Teratol. J3:223-228

Kant GJ e/ al. Long-term sequelae of soman exposure: hormonal rhythms two weeks post-
exposure to a single dose (1988) Fund&Appllbxicol. \0A54-162.

Kimura KK, McNamara BP and Sim VM CRDLR3017 Intravenousadministrationof VX in
man (July 1960) Unclassified Report Edgewood, Maryland: CRDLC, Department of
Defense

LaBorde JB et al Developmental toxicity study of agent GB-DCSM types I and n in NZW
rabbits and CD rats ( 1 986) Jefferson, AR: National Center for Toxicological Research;
AD-A168331.

Marrs, Maynard, Sidell FR Organophosphate nerve agents In: Chemical Warfare Agents.
Toxicology and Treatment. (1996) John Wiley & Sons, pp 83-100

MarzuUi FN, Williams MR MLRR 199 Studies on the evaporation, retention, and penetration
of GB applied to intact human and intact and abraded rabbit skin (July 1953.) Unclassified
Report Edgewood, Maryland: USAMRICD, Department of Defense

McGrath FP, Dutreau CW, Bray EH MDRR49 Toxicity of GB vapor by cutaneous absorption
for monkey and man (April 1951) Unclassified Report. Edgewood, Maryland:
USAMRICTD, Department of Defense

♦National Academy of Sciences (1982) Possible long-term health effects of short-term

exposure to chemical agents. Vol I. Anticholinesterases and anticholinergics. Appendix E
pp 1-6.

•National Academy of Sciences (1982) Possible long-term health effects of short-term

exposure to chemical agents. Vol. 2. Cholinesterase Reactivators, Psychochemicals, and
Irritants and Vesicants.

•National Academy of Sciences. (1983) Possible long-term health effects of short-term

exposure to chemical agents. Vol. 3. Final Report. Current Health Status of Test Subjects.

NeitlickHW CRDLTM2-21 Effect of percutaneous GD on human subjects (September
1965) Unclassified Report.

130

Oberst FW, Koon WS Retention of inhaled sann vapor and its effect on red blood cell
cholinesterase activity in man (1968) ClinFharmacoilher. 9 421-427

Parker RM el al. Thirteen-week oral toxicity studies of tabun (GA) using CD rats (1990)
/bx;co/. 10: 343

Parker RM el al. Subchronic oral toxicity studies of sarin Type I and II and soman using CD rats
(1989) Toxicol. 9 108

Raffaele RC et at. Long-term behavioral changes in rats following organophosphonate exposure
(1987) FharmHiochem&Behav. 21 407-4\2

Rubin LS, Goldberg N4N CWLR2155 Effect of tertiary and quaternary atropine salts on
absolute scotopic threshold changes engendered by GB (7 August 1957) Unclassified
Report Edgewood, Maryland CRDLC, Department of Defense

Russell RW, Booth RA, Lauretz SD el al Behavioural, neurochemical and physiological effects
of repeated exposures to subsymptomatic levels of the antichohnesterase soman (1986)
Neurobehav. Toxicol. Teratol. 8:675-685.

Scremin OU el al. Cerebral blood flow-metabolism coupling after administration of soman at
non-toxic levels (1991) BrainRschBull. 26 253-256

Seed JC MLRR 146 An accident involving vapour exposure to a nerve gas (November 1952)
Unclassified Report Edgewood, Maryland: US AMRICD, Department of Defense

Shih, ML el al. Metabolite pharmacokinetics of soman, sarin and GF in rats and biological
monitoring of exposure to toxic organophosphorus agents (1994) JApplToxicol. 14 195-
199

Shih TA el al. Effects of repeated injection of sublethal doses of soman on behavior and on brain
acetylcholine and choline concentrations in the rat (1987) Aberdeen Proving Ground, MD
TR87-07 U.S. Army Medical Research Institute of Chemical Defense, A182834.

Shih TA et al. Effects of repeated injection of sublethal doses of soman on acetylcholine and
choline contents of the rat brain (1990) Psychopharm. 101:489-496.

Shih T A el al. Metabolite pharmacokinetics of soman, sarin and GF in rats and biological
monitoring of exposure to toxic organophosphorus agents. (1994) JapplToxicol. 14:195-
199

Shih TA el al. Neuroendocrine and immune function two weeks post-exposure to a single dose
of soman. (1990) Aberdeen Proving Ground, MD: TR90-12 US Army Medical Research
Institute of Chemical Defense. A225067.

Shih T A el ai Long-term sequelae of soman exposure: hormonal rhythms two weeks post-
exposure to a single dose (19S%) Fund&ApplToxicoL. \0.287-294

SidellFR EATR4082 Human reposes to intravenous VX (April 1967) Unclassified Report.
Edgewood, Maryland: US AMRICD, Department of Defense

Sidell, FR Soman and sarin: clinical manifestations and treatment of accidental poisoning by
organophosphates. (1974) C//n7bx/co/. 7: 1 - 1 7.

131

Sim VM PTP 53 1 Effect on pupil size of exposure to GB vapour (20 January 1956) Porton
Down, Chemical Defence Establishment, UK, Ministry of Defense.

Sim VM CRDLR 3 122. Variability of different intact human skin sites to the penetration of VX
(February 1962) Unclassified Report Edgewood, Maryland: CRDLC, Department of
Defense

Sim VM, McClure C Jr, Vocci FJ ^/ a/. CRDLR 3231 Tolerance of man to VX contaminated
water. (October 1964) Unclassified Report, Edgewood, Maryland: CRDLC, Department
of Defense

Sim VM, Stubbs JL CRDLR 3015 VX percutaneous studies in man (August 1960)
Unclassified Report Edgewood, Maryland: CRDLC, Department of Defense.

Singer AW e/ a/. Cardiomyopathy in soman and sarin intoxicated rats (1987) ToxicolLetters
36:243-249.

Ward JR, Cosselin R, Comstock J et al. MLRR 151 Case report of a severe human poisoning
byGB (December 1952) Unclassified Report Edgewood, Maryland: USAMRICD,
Department of Defense

Wilson BW, Henderson JD, Chow W, Schreider J, Goldman M, Culbertson R, Dacre JC.
Toxicity of an acute dose of agent VX and other organophosphorus esters in the chicken.
( 1 988) JToxicol&EnvtronHealth 23 : 1 03- 1 1 3

Wilson BWI, Henderson JD, Kellner TP, Goldman M, Higgins RJ, Dacre JC Toxicity of

repeated doses of organophosphorus esters in the chicken. (1988) JToxicol&EnvironHealth

23:115-126.

KEY REFERENCES

Ongoing research on the effects of nerve agent supported by the DoD include the following
extramural projects:

Neuroprotection from OP-Induced Seizures and Neuropathology

Cholinesterase Structure: Identification of Residues and Domains Affecting Organophosphate
Inhibition and Catalysis

Physiologically Based Modeling of C(+)P(+)-Soman Toxicokinetics

Toxicokinetics of 0-ethyl-S-(2-Diisoprophylaminoethyl) Methylphosphonothioate [(+)-VX]-
Identification of Metabolic Pathways

Molecular Targets for Organophosphates in the Central Nervous System

Transgenic Engineering of Cholinesterase: Tools for Exploring Cholinergic Responses

Chronic Organophosphorus Exposure and Cognition

132

Senate Committee oo Veterans' Affairs
September 25, 1996

Question 2: The DoD is developing a Geographic Information System (GIS) that will be a
comprehensive registry of troop movement and exposures durmg the Persian Gulf War. When will
the GIS be completed and available for use by researchers/ Has the DoD developed a protocol
concerning who can have access to the GIS?

Answer: The U.S. Army Center for Health Promotion and Preventive Medicine (CHPPM)
has developed the Troop Exposure Assessment Model (TEAM) which uses geographic information
system (GIS) technology for conducting space and time analyses of Operation Desert Storm troop
unit locations / movements and their relation to the Kuwait oil well fires superplumes. The TEAM
was established in 1993 in response to Public Laws 102-190 (Oil Fires Exposure Registry) and
102-585 (Veterans' Health Status). The TEAM'S databases include the Operation Desert Storm
Personnel Registry (supplied by the Defense Manpower Data Center), the Operation Desert Storm
Troop Unit Movement database (supplied by the U.S. Army and Joint Services Environmental
Support Group), model and satellite derived oil fire superplume boundaries (supplied by the
National Oceanic and Atmospheric Administration), and toxicological / exposure factors (supplied
by DoD and the U.S. Environmental Protection Agency). The TEAM became operational in June
1996 in support of the above Public Laws. These databases are updated as new information
becomes available in terms of additional unit movement data from continued records searches,
improved toxicological data from additional research, and other potential environmental exposure
data from enhanced study into potential incidents. CHPPM has been assessing and integrating
other potential Gulf War environmental exposures (i.e., chemical agents, depleted uranium,
pesticides, etc.) and medical outcomes (i.e., DoD's Comprehensive Clinical Evaluation Program)
data into the TEAM since July 1996. In addition, the CHPPM has started using the TEAM to
analyze potential incidents such as the relation of US Forces to the Khamisiyah munitions
demolitions and Fox/M256 detections.

The CHPPM GIS is already being used by researchers from the DoD and other Federal
agencies such as the Department of Veterans Affairs (VA), as well as researchers from outside the
Federal government working on federally funded investigative efforts on Persian Gulf illnesses
(PGI). Additionally, CHPPM works with other DoD agencies, including the Office of the Special
Assistant for Gulf War Illnesses, the Defense Intelligence Agency, the Naval Health Research
Center and the Defense Manpower Data Center. CHPPM is also collaborating with several
federally funded investigators. These groups include, the University of Iowa, the Centers for
Disease Control and Prevention, the VA's Boston Environmental Hazards Center, and the Klemm
Analysis Group, Inc.

DoD will be coordinating with the Persian Gulf Veterans' Coordinating Board, Research
Working Group, to develop and implement a formal procedure regarding researchers' access to
TEAM GIS data.

133

Senate Committee on Veterans' Affairs
September 25, 1996

Question 3: I had the opportunity to review the "Report on Possible
Effects of Organophosphates 'Low-Level ' Nerve Agent Exposure " that was
prepared by the Persian Gulf Illness ' Investigation Team. One of the citations in
the literature review is a personal communication from Dr. Fred Sidell — one of
the leading researchers in the field. Has that personal communications been
published? I would like to obtain a copy of it. I think it is important for it to
become part of the public record so that other researchers might have access to it.

Answer: The personal communication from Dr. Fred Sidell has not been
published. Dr. Sidell stated that the original discussion was a phone conversation
referencing symptomatic high-dose nerve agent exposure as compared to low-dose
asymptomatic nerve agent exposure. However, concerning the citation in the literature
review, information pertaining to health effects of chemical weapons is located on the
InterNet and in a textbook which is expected to be published by February 28, 1997. Dr.
Sidell quoted three references which address the personal communication:

1. InterNet - www.dtic.mil/gulflink/fmalagt.htm

2. InterNet - www.gulfwar.org/index.html

3. The Borden Institute Textbook of Military Medicine, Medical Aspects

of Chemical and Biological Warfare, 14 January 1997, editor -
Colleen Quick;TeIephone (202)782-7572

BOSTON PUBLIC LIBRARY

3 9999 05983 959 5

ISBN 0-16-055153-6

780160"551536

90000

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